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Ford AC, Staudacher HM, Talley NJ. Postprandial symptoms in disorders of gut-brain interaction and their potential as a treatment target. Gut 2024:gutjnl-2023-331833. [PMID: 38697774 DOI: 10.1136/gutjnl-2023-331833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/23/2024] [Indexed: 05/05/2024]
Abstract
Postprandial, or meal-related, symptoms, such as abdominal pain, early satiation, fullness or bloating, are often reported by patients with disorders of gut-brain interaction, including functional dyspepsia (FD) or irritable bowel syndrome (IBS). We propose that postprandial symptoms arise via a distinct pathophysiological process. A physiological or psychological insult, for example, acute enteric infection, leads to loss of tolerance to a previously tolerated oral food antigen. This enables interaction of both the microbiota and the food antigen itself with the immune system, causing a localised immunological response, with activation of eosinophils and mast cells, and release of inflammatory mediators, including histamine and cytokines. These have more widespread systemic effects, including triggering nociceptive nerves and altering mood. Dietary interventions, including a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols, elimination of potential food antigens or gluten, IgG food sensitivity diets or salicylate restriction may benefit some patients with IBS or FD. This could be because the restriction of these foods or dietary components modulates this pathophysiological process. Similarly, drugs including proton pump inhibitors, histamine-receptor antagonists, mast cell stabilisers or even tricyclic or tetracyclic antidepressants, which have anti-histaminergic actions, all of which are potential treatments for FD and IBS, act on one or more of these mechanisms. It seems unlikely that food antigens driving intestinal immune activation are the entire explanation for postprandial symptoms in FD and IBS. In others, fermentation of intestinal carbohydrates, with gas release altering reflex responses, adverse reactions to food chemicals, central mechanisms or nocebo effects may dominate. However, if the concept that postprandial symptoms arise from food antigens driving an immune response in the gastrointestinal tract in a subset of patients is correct, it is paradigm-shifting, because if the choice of treatment were based on one or more of these therapeutic targets, patient outcomes may be improved.
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Affiliation(s)
- Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK
| | - Heidi M Staudacher
- Deakin University-Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Nicholas J Talley
- Health, University of Newcastle, Callaghan, New South Wales, Australia
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Deutsch D, Bouchoucha M, Uzan J, Airinei G, Sabate JM, Benamouzig R. Relationship Between Colonic Transit Response to Eating With Self-reported Constipation Severity in Constipated Patients According to the Phenotype. J Neurogastroenterol Motil 2024; 30:97-105. [PMID: 38173161 PMCID: PMC10774807 DOI: 10.5056/jnm21091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 04/29/2023] [Accepted: 05/11/2023] [Indexed: 01/05/2024] Open
Abstract
Background/Aims Eating is the major synchronizer of gastrointestinal motility and secretions. The present study aims to evaluate the interplay between self-perceived constipation severity (CS) and colonic response to eating in constipated patients according to the phenotype. Methods We included 387 consecutive outpatients complaining of Rome IV chronic idiopathic constipation. Likert scales for CS, abdominal pain severity, bloating severity, depression and anxiety assessment, total and segmental colonic transit time (CTT), and colonic transit response to eating (CTRE) were performed in all patients. Results Of the 387 patients included (49.7 ± 16.4 years), 320 (83%) were female, 203 had irritable bowel syndrome with constipation (IBS-C), 184 as functional constipation (FC), and 283 had defecation disorders (DD). The female gender was characterized by increased bloating severity (P = 0.011) and decreased Bristol stool form (P = 0.002). In IBS-C and FC patients, CS was related with bloating severity (P < 0.001 in both groups) and total CTT (P = 0.007 in IBS-constipation, P = 0.040 in FC). In IBS-C patients, CS was also associated with abdominal pain severity (P = 0.003) and Bristol stool form (P = 0.004). In contrast, in FC, CS was only related to left CTRE (P = 0.006), and in patients with DD, CS was associated with total CTT (P < 0.001) and left CTRE (P = 0.002). Conclusion Colonic transit response to eating was not associated to CS in IBS-C patients, but left CTRE was associated with constipation severity in FC and DD patients.
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Affiliation(s)
- David Deutsch
- Department of Gastroenterology, Hôpital Avicenne, Bobigny, France
| | - Michel Bouchoucha
- Department of Gastroenterology, Hôpital Avicenne, Bobigny, France
- Department of Physiology, Université de Paris, Paris, France
| | - Julien Uzan
- Department of Gastroenterology, Hôpital Avicenne, Bobigny, France
| | - Gheorghe Airinei
- Department of Gastroenterology, Hôpital Avicenne, Bobigny, France
| | - Jean-Marc Sabate
- Department of Gastroenterology, Hôpital Avicenne, Bobigny, France
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Food Avoidance and Restriction in Irritable Bowel Syndrome: Relevance for Symptoms, Quality of Life and Nutrient Intake. Clin Gastroenterol Hepatol 2022; 20:1290-1298.e4. [PMID: 34229035 DOI: 10.1016/j.cgh.2021.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Neither food intake nor the clinical characteristics of irritable bowel syndrome (IBS) patients with severe food avoidance and restriction have been investigated. The aim of our study was to identify those patients and to characterize their symptoms, quality of life, and nutrient intake. METHODS IBS patients who completed the IBS Quality of Life Instrument (IBS-QOL) at our secondar and tertiary center were included. The 3 questions constituting the food domain were used to identify patients with reported severe food avoidance and restriction. The patients also completed validated questionnaires to assess stool form (Bristol Stool Form), gastrointestinal (GI) symptom severity (z score of IBS Severity Scoring System and Gastrointestinal Symptom Rating Scale-IBS), psychological distress (Hospital Anxiety and Depression Scale), GI-specific anxiety (Visceral Sensitivity Index), and somatic symptom severity (z score of Symptom Checklist-90-Revised and Patient Health Questionnaire-15). A 4-day food diary was used to analyze food intake in 246 patients. RESULTS We included 955 IBS patients (75 % women; mean age 38.3 ± 13.3 years). In total, 13.2 % of the patients reported severe food avoidance and restriction, and in these patients all aspects of quality of life were lower (P < .01) and psychological, GI, and somatic symptoms were more severe (P < .05). Reported severe food avoidance and restriction was associated with lower total energy intake (P = .002) and lower intake of protein (P = .001) and carbohydrates (P = .005). In a logistic regression analysis, loose stools were found to be independently associated with reported severe food avoidance and restriction (R2 = 0.062). CONCLUSIONS IBS patients with severe food avoidance and restriction constitute a subgroup with more severe symptoms overall, reduced quality of life, and reduced intake of nutrients. This needs to be acknowledged in the clinical management of these patients.
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Bouchoucha M, Fysekidis M, Rompteaux P, Raynaud JJ, Sabate JM, Benamouzig R. Lactose Sensitivity and Lactose Malabsorption: The 2 Faces of Lactose Intolerance. J Neurogastroenterol Motil 2021; 27:257-264. [PMID: 33361550 PMCID: PMC8026364 DOI: 10.5056/jnm20094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/25/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Self-reported lactose intolerance (LI) is frequent in patients with functional bowel disorders (FBD) that could be interpreted as irritable bowel syndrome (IBS). The present study aims to characterize the responses of patients with FBD, without small intestinal bacterial overgrowth (SIBO), and LI, in terms of lactose malabsorption (LM) and lactose sensitivity (LS) according to psychological and clinical features. Methods One hundred and fifty-eight consecutive FBD outpatients with LI, and no SIBO, were classified according to the Rome III questionnaire and filled Beck Depression Inventory, and State and Trait Anxiety questionnaires. They underwent a lactose tolerance test in which glycemia during 60 minutes and digestive symptoms for 3 hours were recorded. Results Abnormal lactose tolerance tests were found in 110 patients (70%), 44 (28%) with LM, 96 (61%) with LS, and 30 (19%) having both LM and LS. LM patients had a higher frequency of functional diarrhea (P = 0.040) and a lower frequency of dysphagia (P = 0.031). LS patients had a higher depression score (P = 0.007), higher frequency of globus (P = 0.042), irritable bowel syndrome (IBS) (P = 0.027) and mixed IBS (P = 0.049), and lower frequency of abdominal pain (P = 0.040). LS was significantly associated with a higher depression score (P = 0.002), and a higher frequency of globus (P = 0.046). Conclusions Thirty percent of LI patients have normal lactose absorption and normal LS. In the other 70% of patients, LI could be associated with LM and/or LS.
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Affiliation(s)
- Michel Bouchoucha
- epartment of Physiology, Université René Descartes, Paris V, Paris, France.,Department of Gastroenterology, Avicenne Hospital, Bobigny, France
| | | | - Pierre Rompteaux
- Department of Gastroenterology, Avicenne Hospital, Bobigny, France
| | | | - Jean-Marc Sabate
- Department of Gastroenterology, Avicenne Hospital, Bobigny, France
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Siah KTH, Gong X, Yang XJ, Whitehead WE, Chen M, Hou X, Pratap N, Ghoshal UC, Syam AF, Abdullah M, Choi MG, Bak YT, Lu CL, Gonlachanvit S, Boon CS, Fang F, Cheong PK, Wu JCY, Gwee KA. Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters. Gut 2018; 67:1071-1077. [PMID: 28592440 DOI: 10.1136/gutjnl-2016-312852] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 03/29/2017] [Accepted: 04/24/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Functional gastrointestinal disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID. DESIGN 1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters. RESULTS Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence). CONCLUSION We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.
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Affiliation(s)
- Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore.,Department of Internal Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xiaorong Gong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yet-Sen University, Guangzhou, China
| | - Xi Jessie Yang
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - William E Whitehead
- Centre for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yet-Sen University, Guangzhou, China
| | - Xiaohua Hou
- Department of Gastroenterology and Hepatology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nitesh Pratap
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ari F Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Myung-Gyu Choi
- Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Tae Bak
- Department of Gastroenterology, Korea University Guro Hospital, Seoul, South Korea
| | - Ching-Liang Lu
- Division of Gastroenterology, Taipei Veterans General Hospital, National Yang-Ming University Taipei, Taiwan National Yang-Ming University Taipei, Taipei, Taiwan
| | - Sutep Gonlachanvit
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | | | - Fan Fang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Pui Kuan Cheong
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Kok-Ann Gwee
- Department of Internal Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Fysekidis M, Bouchoucha M, Mary F, Airinei G, Bon C, Benamouzig R. Change of appetite in patients with functional digestive disorder. Association with psychological disorders: A cross-sectional study. J Gastroenterol Hepatol 2018; 33:195-202. [PMID: 28556178 DOI: 10.1111/jgh.13836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Changes in appetite are a frequent complaint in patients with functional gastrointestinal disorders (FGIDs). The aims of this study are to evaluate whether the changes in appetite are associated with specific FGIDs and to explore associations of these changes with symptoms of anxiety or depression. METHODS This study included 1009 consecutive FGID patients (71% female), aged 48.9 years who all filled out a Rome III questionnaire for the evaluation of FGIDs, submitted to a psychological evaluation of symptoms of anxiety, and completed the Beck Depression Inventory questionnaire. The patients were classified according to their appetite change using a 7-point grading scale and split into three groups: those with appetite loss, those with no change in appetite, and those with increased appetite. RESULTS Among the 1009, 496 patients (49%) reported a change in appetite, of which 332 (33%) patients reported a decrease in appetite and 164 (16%) patients reported an increase in appetite. Appetite was not affected in 51% of patients. Changes in appetite depended on gender, body mass index and psychometric evaluation scores. Increased appetite did not have specific FGIDs associations, while decreased appetite was associated with esophageal, gastroduodenal, bowel, and anorectal symptoms. The presence of depressive symptoms was also a predictor for the majority of FGIDs in decreased appetite, while anxiety trait was significant for globus and dysphagia. CONCLUSIONS Decreased appetite was associated with FGIDs, especially in the presence of depressive symptoms. A reduced appetite would help to predict psychological disorders associated with FGIDs. FINANCIAL DISCLOSURE None declared. LEGAL REGISTRATION This study was a registered study in the French National Drug Agency (ANSM, Agence Nationale de Securité du Medicamentet des produits de santé, Study Number 2016-A01120-51). COMPETING INTERESTS Michel Bouchoucha, Marinos Fysekidis, Florence Mary, Gheorghe Airinei, Cyriaque Bon, and Robert Benamouzig have no competitive interests.
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Affiliation(s)
- Marinos Fysekidis
- Service de Nutrition et Diabétologie, Hôpital Avicenne, Paris, France
| | - Michel Bouchoucha
- Université Paris V René Descartes, Paris, France.,Service de Gastroentérologie, Hôpital Avicenne, Paris, France
| | - Florence Mary
- Service de Gastroentérologie, Hôpital Avicenne, Paris, France
| | | | - Cyriaque Bon
- Service de Gastroentérologie, Hôpital Avicenne, Paris, France
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Riezzo G, Chimienti G, Clemente C, D'Attoma B, Orlando A, Mammone Rinaldi C, Russo F. Colonic Transit Time and Gut Peptides in Adult Patients with Slow and Normal Colonic Transit Constipation. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3178263. [PMID: 29082242 PMCID: PMC5610809 DOI: 10.1155/2017/3178263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/07/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate whether pathophysiological differences exist among healthy controls (HC) and patients with slow and normal transit constipation (STC and NTC), we evaluated (1) gastrointestinal (GI) symptoms using validated questionnaires; (2) circulating concentrations of neurotensin, motilin, corticotrophin-releasing factor (CRF), and somatostatin; and (3) possible differences in frequency distribution of the neurotensin rs1800832 A/G and Neurotensin Receptor 1 rs6090453 C/G SNPs. METHODS Fifty-one patients with severe functional constipation and 20 HC completed the study. Symptoms were evaluated by GSRS and Constipaq scoring system. Plasma concentrations of GI peptides were evaluated by ELISA on fasting and six sequential blood samples after a standard meal. Genotyping was performed by PCR and endonuclease digestion. RESULTS Symptom profiles largely overlapped between NTC and STC patients. As for peptide profiles, neurotensin showed lower concentrations at 60 and 90 min in STC versus HC, and motilin showed throughout the curve 85% and 82% lower levels in STC than HC and NTC, respectively. Finally, neurotensin polymorphism resulted in being associated with the peptide levels. CONCLUSIONS Symptom profile is not a reliable tool to discriminate STC, whilst the GI peptide profiles might help in identifying it.
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Affiliation(s)
- Giuseppe Riezzo
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases, IRCCS “Saverio de Bellis”, Castellana Grotte, Bari, Italy
| | - Guglielmina Chimienti
- Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari, Bari, Italy
| | - Caterina Clemente
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases, IRCCS “Saverio de Bellis”, Castellana Grotte, Bari, Italy
| | - Benedetta D'Attoma
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases, IRCCS “Saverio de Bellis”, Castellana Grotte, Bari, Italy
| | - Antonella Orlando
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases, IRCCS “Saverio de Bellis”, Castellana Grotte, Bari, Italy
| | - Caterina Mammone Rinaldi
- Department of Radiology and Imaging, National Institute of Digestive Diseases, IRCCS “Saverio de Bellis”, Castellana Grotte, Bari, Italy
| | - Francesco Russo
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases, IRCCS “Saverio de Bellis”, Castellana Grotte, Bari, Italy
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Clinical, psychological, and physiological correlates of patients who defecate after meal. Eur J Gastroenterol Hepatol 2017; 29:174-180. [PMID: 27824643 DOI: 10.1097/meg.0000000000000777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Food is the most important synchronizer of gastrointestinal motility and secretion. Many patients with functional bowel or anorectal disorders complain of fecal urge and stool output after eating. PATIENTS AND METHODS In this prospective observational study, 408 consecutive outpatients with functional bowel and/or anorectal disorders (74% female, 50.2±15.6 years, 24.8±5.0 kg/m²) filled Rome III questionnaires. Depression and anxiety scores, a physiological evaluation (total and segmental colonic transit time, colonic transit response to eating using a standard 1000 kcal test meal, and anorectal manometry), were measured. Univariate analysis and multivariate logistic regression were carried out according to the presence or not of stool output after eating. RESULTS Defecation after eating was found in 21% of patients. These patients were not different according to the demographic characteristics of sex ratio (P=0.702), age (P=0.830), and BMI (P=0.314). In contrast, they had lower state anxiety (P=0.032), but similar scores of depression (P=0.240) and trait anxiety (P=0.933). They had similar manometric characteristics (anal pressure and rectal sensitivity), but a greater response to eating in all segments of the colon. There was an increase in the frequency of functional diarrhea (odds ratio=2.576, 95% confidence interval=1.312-5.056; P=0.006) and levator ani syndrome (odds ratio=2.331, 95% confidence interval=1.099-4.944; P=0.017), but no other functional bowel disorder including irritable bowel syndrome and its subtypes was found. CONCLUSION Stool output after eating is associated with clinical disorders but not physiological parameters. This symptom is not associated with irritable bowel syndrome, but a higher frequency of functional diarrhea.
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Whitehead WE, Palsson OS, Simrén M. Biomarkers to distinguish functional constipation from irritable bowel syndrome with constipation. Neurogastroenterol Motil 2016; 28:783-92. [PMID: 27214096 DOI: 10.1111/nmo.12852] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/13/2016] [Indexed: 12/15/2022]
Abstract
Treatments for functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C) differ, but symptom criteria do not reliably distinguish between them; some regard FC and IBS-C as parts of a single constipation spectrum. Our goal was to review studies comparing FC and IBS-C to identify possible biomarkers that separate them. A systematic review identified 15 studies that compared physiologic tests in FC vs IBS-C. Pain thresholds were lower in IBS-C than FC for 3/5 studies and not different in 2/5. Colonic motility was decreased more in FC than IBS-C for 3/3 studies, and whole gut transit was delayed more in FC than IBS-C in 3/8 studies and not different in 5/8. Pelvic floor dyssynergia was unrelated to diagnosis. Sympathetic arousal, measured in only one study, was greater in IBS-C than FC. The most reliable separation of FC from IBS-C was shown by a novel new magnetic resonance imaging technique described in this issue of the journal. These authors showed that drinking one liter of polyethylene glycol laxative significantly increased water content in the small intestine, volume of contents in the ascending colon, and time to first evacuation in FC vs IBS-C; and resulted in less colon motility and delayed whole gut transit in FC compared to IBS-C. Although replication is needed, this well-tolerated, non-invasive test promises to become a new standard for differential diagnosis of FC vs IBS-C. These data suggest that FC and IBS-C are different disorders rather than points on a constipation spectrum.
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Affiliation(s)
- W E Whitehead
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - O S Palsson
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Simrén
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bouchoucha M, Devroede G, Bon C, Raynaud JJ, Bejou B, Benamouzig R. How many segments are necessary to characterize delayed colonic transit time? Int J Colorectal Dis 2015; 30:1381-9. [PMID: 26062871 DOI: 10.1007/s00384-015-2277-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Measuring colonic transit time with radiopaque markers is simple, inexpensive, and very useful in constipated patients. Yet, the algorithm used to identify colonic segments is subjective, rather than founded on prior experimentation. The aim of the present study is to describe a rational way to determine the colonic partition in the measurement of colonic transit time. METHODS Colonic transit time was measured in seven segments: ascending colon, hepatic flexure, right and left transverse colon, splenic flexure, descending colon, and rectosigmoid in 852 patients with functional bowel and anorectal disorders. An unsupervised algorithm for modeling Gaussian mixtures served to estimate the number of subgroups from this oversegmented colonic transit time. After that, we performed a k-means clustering that separated the observations into homogenous groups of patients according to their oversegmented colonic transit time. RESULTS The Gaussian mixture followed by the k-means clustering defined 4 populations of patients: "normal and fast transit" (n = 548) and three groups of patients with delayed colonic transit time "right delay" (n = 82) in which transit is delayed in the right part of the colon, "left delay" (n = 87) with transit delayed in the left part of colon and "outlet constipation" (n = 135) for patients with transit delayed in the terminal intestine. Only 3.7 % of patients were "erroneously" classified in the 4 groups recognized by clustering. CONCLUSIONS This unsupervised analysis of segmental colonic transit time shows that the classical division of the colon and the rectum into three segments is sufficient to characterize delayed segmental colonic transit time.
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Affiliation(s)
- Michel Bouchoucha
- , Université Paris V René Descartes 15, Rue de l'Ecole de Médecine, 75270, Paris Cedex 06, France. .,Hôpital Avicenne. Service de Gastroentérologie, 125, Rue de Stalingrad, 93009, Bobigny Cedex, France.
| | - Ghislain Devroede
- Département de Chirurgie, Faculté de Médecine, Université de Sherbrooke, CHUS, 3001 12 e Avenue Nord, Sherbrooke, Quebec, J1H5N4, Canada
| | - Cyriaque Bon
- , Université Paris V René Descartes 15, Rue de l'Ecole de Médecine, 75270, Paris Cedex 06, France
| | - Jean-Jacques Raynaud
- , Université Paris V René Descartes 15, Rue de l'Ecole de Médecine, 75270, Paris Cedex 06, France
| | - Bakhtiar Bejou
- , Université Paris V René Descartes 15, Rue de l'Ecole de Médecine, 75270, Paris Cedex 06, France
| | - Robert Benamouzig
- , Université Paris V René Descartes 15, Rue de l'Ecole de Médecine, 75270, Paris Cedex 06, France
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DuPont AW, Jiang ZD, Harold SA, Snyder N, Galler GW, Garcia-Torres F, DuPont HL. Motility abnormalities in irritable bowel syndrome. Digestion 2014; 89:119-23. [PMID: 24503633 DOI: 10.1159/000356314] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 10/04/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS The intestinal pathophysiology in irritable bowel syndrome (IBS) is largely unknown. The lactulose breath test has been used to identify small bowel bacterial overgrowth in these patients. METHODS We studied intestinal transit in patients with IBS using of the SmartPill® (SP) wireless pH/pressure recording capsule and performed lactulose breath tests to look for physiologic abnormalities. RESULTS A total of 35/46 (76%) of the IBS patients had prolonged gastric emptying times. Constipation-predominant disease was associated with prolonged gut transit times. The mean hours ± SD for colonic transit time in the constipation group was 71.7 ± 61.1 (n = 13) compared with 22.5 ± 14.9 (n = 14) for diarrhea-predominant and 26.4 ± 21.5 (n = 20) for mixed clinical subtype (p = 0.0010). No correlation between small bowel transit time and abnormal breath hydrogen or methane excretion in the 46 combined patients with IBS was seen. CONCLUSIONS Delayed gastric emptying was identified in IBS and in some patients may contribute to at least a component of their symptoms. Constipation-predominant IBS is associated with prolonged gut transit times. Otherwise, transit abnormalities do not appear to be important in IBS. Intestinal transit did not correlate with breath test results.
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Affiliation(s)
- Andrew W DuPont
- The University of Texas Health Science Center, Houston, Tex., USA
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Bouchoucha M, Fysekidis M, Devroede G, Raynaud JJ, Bejou B, Benamouzig R. Abdominal pain localization is associated with non-diarrheic Rome III functional gastrointestinal disorders. Neurogastroenterol Motil 2013; 25:686-93. [PMID: 23710967 DOI: 10.1111/nmo.12149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/08/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Abdominal pain is common in patients with functional bowel disorders (FBDs). The aim of this study was to characterize the predominant sites of abdominal pain associated with FBD subtypes, as defined by the Rome III criteria. METHODS A total of 584 consecutive patients attending FBD consultations in a tertiary center participated in the study. Stool form, abdominal pain location (nine abdominal segments), and pain intensity (10-point Likert scale) during the previous week were recorded. Logistic regression analysis was used to characterize the association of abdominal pain sites with specific FBD subtypes. KEY RESULTS FBDs were associated with predominant pain sites. Irritable bowel syndrome (IBS) with constipation was associated with pain in the left flank and patients were less likely to report pain in the right hypochondrium. Patients with functional constipation reported pain in the right hypochondrium and were less likely to report pain in the left flank and left iliac site. IBS with alternating constipation and diarrhea was associated with pain in the right flank, and unsubtyped IBS with pain in the hypogastrium Patients with functional abdominal pain syndrome reported the lower right flank as predominant pain site. Patients with unspecified FBDs were least likely to report pain in the hypogastrium. Patients with functional diarrhea, IBS with diarrhea, or functional bloating did not report specific pain sites. CONCLUSIONS & INFERENCES The results from this study provide the basis for developing new criteria allowing for the identification of homogeneous groups of patients with non-diarrheic FBDs based on characteristic sites of pain.
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Affiliation(s)
- M Bouchoucha
- Service de Physiologie, Université René Descartes, Paris V, Paris, France.
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Mangel AW, Hicks GA. Asimadoline and its potential for the treatment of diarrhea-predominant irritable bowel syndrome: a review. Clin Exp Gastroenterol 2012; 5:1-10. [PMID: 22346361 PMCID: PMC3278196 DOI: 10.2147/ceg.s23274] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a multifactorial condition with principal symptoms of pain and altered bowel function. The kappa-opioid agonist asimadoline is being evaluated in Phase III as a potential treatment for IBS. Asimadoline, to date, has shown a good safety profile and the target Phase III population - diarrhea-predominant IBS patients with at least moderate pain - was iteratively determined in a prospective manner from a Phase II dose-ranging study. The clinical data in support of this population are reviewed in this article. Furthermore, the scientific rationale for the use of asimadoline in the treatment of IBS is reviewed. Considering the high patient and societal burdens of IBS, new treatments for IBS represent therapeutic advances.
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