Irritable Bowel Syndrome: Epidemiology, Pathophysiology, Diagnosis, and Treatment

Adherence to the Mediterranean Diet in Paediatric Patients with Inflammatory Bowel Disease and Functional Abdominal Pain Disorders-Comparative Study

Background/Objectives: There is a limited body of evidence regarding dietary intake in children with inflammatory bowel disease despite increasing research about the nutritional implications in the disease pathogenesis. Functional abdominal pain disorders (FAPDs) are also chronic disorders marked by chronic abdominal pain, currently described with the ROME IV criteria. This study was aimed to investigate the adherence to healthy eating habits in an inflammatory bowel disease pediatric population when compared to a matched population with functional abdominal pain gastrointestinal disorders. Methods: We performed a single centre study focused on dietary patterns in children with IBD and FAPDs between January 2021 and April 2024. Data collected included general information, disease phenotype, and the KIDMED index regarding healthy eating. Results: The final analysis was based on full data from the KIDMED index available for 122 (57 vs. 65) participants. Overall, the average KIDMED score did not vary significantly between the study population, meaning 6.89 ± 2.33 for the IBD group and 7.11 ± 2.67 for FAPDs group, p = 0.34. In the same KIDMED index group, mean values were higher for FAPDs patients, but results differ statistically significant only for "medium" adherence to healthy diet, showing that larger proportion of IBD patients were previously exposed to non-healthy diets: 8.99 vs. 11.1, p = 0.45, 5.02 vs. 6.92, p = 0.05, 2.89 vs. 2.56, p = 0.43, for group 1, 2, and 3, respectively. Conclusions: This study showed in our cohort that overall adherence to a healthy pattern diet is poor prior to diagnosis of different gastrointestinal pathologies in children.

Association between adverse childhood experiences and gastro-esophageal diseases later in life: A large-population cohort and Mendelian randomization study

BACKGROUND

Adverse childhood experiences (ACEs) are widely recognized as associated with stress-associated digestive disorders, yet their comprehensive relationship with gastro-esophageal diseases as well as the potential mechanisms of depression remains underexplored.

METHODS

The prospective study included 133,638 participants aged 40-69 from UK Biobank with full information on ACEs, depression, and gastro-esophageal diseases. ACEs were retrospectively measured both as individual types (physical, emotional, and sexual abuse, and physical and emotional neglect) and cumulative scores of experienced types. Cox proportional hazards model was utilized to assess the association of ACEs with the overall and type-specific risks of diseases. Two-sample Mendelian randomization (TSMR) was conducted utilizing data from a genome-wide association study of ACEs (N = 185,414) to further examine the causal relationship. Mediation analysis was performed to quantify the role of depression.

RESULTS

During a median follow-up of 13.3 years, those who had a history of ACEs were observed with a 15 % higher overall risk of gastro-esophageal diseases (HR, 1.15; 95%CI, 1.12-1.19) and 10-25 % increased type-specific risks compared to unexposed participants. Among five individual types of ACEs, the association was more prominent for emotional abuse (1.22, 1.17-1.27) and sexual abuse (1.24, 1.18-1.30). TSMR analysis consistently reported positive associations between ACE and four subtypes of gastro-esophageal diseases. Depression was found to mediate 17.2 % (13.5 %, 24.0 %) of the aforementioned relationship.

CONCLUSIONS

Our findings highlight the importance of early screening and intervention on ACEs to reduce the long-term risk of gastro-esophageal diseases, and stress the potential of depression as a ponderable indirect intervention target.

Potentiation of visualized exosomal miR-1306-3p from primary sensory neurons contributes to chronic visceral pain via spinal P2X3 receptors

ABSTRACT

Exosomes served as "communicators" to exchange information among different cells in the nervous system. Our previous study demonstrated that the enhanced spinal synaptic transmission contributed to chronic visceral pain in irritable bowel syndrome. However, the underlying mechanism of primary sensory neuron (PSN)-derived exosomes on spinal transmission remains unclear. In this study, an exosome visualization method was established to specifically track exosomes derived from PSNs in CD63-GFPf/+ (green fluorescent protein) mice. Neonatal maternal deprivation (NMD) was adopted to induce chronic visceral pain in CD63-GFPf/+ male mice. The exosome visualization technology demonstrated that NMD increased visible PSN-derived exosomes in the spinal dorsal horn, enhanced spinal synaptic transmission, and led to visceral pain in CD63-GFPf/+ male mice. The PSN-derived exosomal miR-1306-3p sorted from spinal dorsal horn activated P2X3R, enhanced spinal synaptic transmission, and led to visceral pain in NMD mice. Moreover, upregulation of Rab27a in dorsal root ganglia mediated the increased release of PSN-derived exosomes, and intrathecal injection of siR-Rab27a reduced visible PSN-derived exosomes in spinal cord, suppressed spinal synaptic transmission, and alleviated visceral pain in NMD mice. This and future studies would reveal the detailed mechanisms of PSN-derived exosomes and provide a potential target for clinical treatment of chronic visceral pain in patients with irritable bowel syndrome.

Effect of Acupuncture on Anxiety, Depression, and Quality of Life in Patients with Irritable Bowel Syndrome: A Meta-Analysis

BACKGROUND

Irritable bowel syndrome (IBS) has been effectively treated with acupuncture, but the significance of quality of life, depression, and anxiety in the assessment of IBS patients has received little consideration. This study examined the impact of acupuncture on depression, anxiety, and quality of life in IBS patients.

METHOD

PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), EMBASE, China Science and Technology Journal Database (VIP), Chinese Biological Medical (CBM, SinoMed) Database, and the Wan Fang Database were among the electronic databases from which relevant randomized controlled trials (RCTs) were systematically retrieved between their inception and July 2023. The outcomes included adverse events, total response rate, anxiety, and symptoms of depression, as well as quality of life. In this study, the heterogeneity, publication bias, standardized mean difference (SMD), and risk ratios (RR) with 95% confidence intervals (CI) were estimated.

RESULTS

In this study, 29 RCTs including 3114 participants for analysis (treatment group, 1730; control group, 1384) were included. Compared to other therapies, acupuncture significantly improved the quality of life (SMD = 0.61, 95% CI = [0.26, 0.96], P < 0.001) and alleviated anxiety (SMD =  - 0.72, 95% CI = [- 1.76, 0.32], P = 0.18) and depression (SMD =  - 0.74, 95% CI = [- 1.18, - 0.3], P < 0.001) in IBS patients. A statistically significant improvement was recorded in their quality of life, and they also displayed fewer symptoms of depression. The total response rate (RR = 1.18, 95% CI = [1.12, 1.25], P < 0.001) indicated that acupuncture significantly affected IBS treatment in comparison to other methods. Subgroup analysis of primary outcome indicators revealed that acupuncture demonstrated better results regardless of the duration of intervention and was more effective than Western medicine or sham acupuncture. In addition to the total response rate (I2 = 0%), the other three outcome indicators showed significant heterogeneity (I2 > 50%). No publication bias was noted in RR (P < 0.05); however, a significant publication bias was observed in quality of life (P > 0.05).

CONCLUSION

Acupuncture can enhance the quality of life and relieve anxiety and depression in patients with IBS with apparent safety; however, a large number of high-quality RCTs are still needed.

Chinese herbal formula Tongxie Yaofang granules for diarrhoea-predominant irritable bowel syndrome: a randomised, double-blind, placebo-controlled, phase II trial

OBJECTIVES

To assess the therapeutic effects and safety of Tongxie Yaofang (TXYF) granules vs placebo as an alternative treatment for diarrhoea-predominant irritable bowel syndrome (IBS-D). We hypothesised that TXYF would improve clinical responses among patients with IBS-D.

DESIGN

A randomised, double-blind, placebo-controlled, phase II, superiority trial.

SETTING

Outpatients attending the Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China.

PARTICIPANTS

96 eligible participants included men and women ranging from late adolescence to middle adulthood (18-65 years), diagnosed with IBS-D according to the Rome IV criteria. In addition, they were required to have an irritable bowel syndrome symptom severity score (IBS-SSS) of at least 75.

INTERVENTIONS

TXYF granules (3.7 g) twice daily (taken orally before meals) or placebo for 8 weeks.

PRIMARY AND SECONDARY OUTCOMES

The primary outcome was the response rate measured by the change in IBS-SSS compared with baseline at week 8. Secondary outcomes included stool frequency; stool consistency at weeks 4, 8 and 20; and quality of life, anxiety and depression at week 8; and safety was monitored throughout the trial.

RESULTS

The TXYF and placebo groups each comprised 48 participants. The response rate was not significantly different at week 8 between the two groups (the unadjusted treatment effect estimate (intention-to-treat analysis) was 1.12 (95% CI (0.89, 1.41)), p=0.348). Both groups had a high and similar rate of symptom reduction (79.2% (38/48) vs 70.8% (34/48)). There were no statistically significant differences between the two groups on secondary outcomes, although both groups showed substantial improvements. Adverse events in the TXYF and placebo groups were one (sinus arrhythmia) and two (elevated transaminases, weakly positive faecal occult blood), respectively. No serious adverse events occurred.

CONCLUSIONS

Despite showing clinically meaningful improvements in IBS-D symptoms and a reasonable safety profile after 8 weeks, no significant differences were observed between the TXYF and placebo groups. This suggests that the severity of IBS-D symptoms in both treatment arms might have decreased over time, regardless of the treatment, and highlights the need to investigate the relationship between IBS-D and patient psychology. Future large-scale, rigorously designed trials with longer treatment and follow-up periods are essential to evaluate the therapeutic effects and safety of TXYF, and to explore the psychological factors.

TRIAL REGISTRATION NUMBER

ISRCTN12453166.

Overexpression of MCL1 attenuates irritable bowel syndrome by regulating cuproptosis: Screening and validation

Irritable bowel syndrome (IBS) is a type of chronic bowel disorder with a poorly understood pathophysiology. Recently, the imbalance of copper has been reported to influence the progression of IBS, suggesting cuproptosis, a new type of copper-induced cell death, may play a role in IBS. This study found 17 cuproptosis-related differentially expressed genes in IBS through bioinformatic analysis. Six hub genes were identified after the protein-protein interaction network analysis, namely myeloid cell leukemia 1 (MCL1), epidermal growth factor receptor 2, cadherin-associated protein beta 1, solute carrier family 25 members 37, solute carrier family 39 members 14, and six transmembrane epithelial antigens of the prostate 3. We selected MCL1 for further verification. Human normal colon epithelial cell line (NCM460) was used to construct models of IBS or cuproptosis in vitro by lipopolysaccharide (LPS) or LPS combined with copper (II) chloride (CuCl2). We observed that overexpression of MCL1 promoted cell viability and proliferation ability, and inhibited the secretion of inflammatory factors and expression of Bax and caspase-3 of NCM460 cells treated with LPS or LPS combined with CuCl2. In addition, up-regulated MCL1 significantly suppressed the protein levels of ferredoxin 1 and lipoyl synthase, two key regulators of cuproptosis. In conclusion, our study demonstrates that cuproptosis is involved in IBS and identifies a cuproptosis-related gene, MCL1, that helps alleviate IBS by promoting cell growth, reducing inflammation, and suppressing cuproptosis, making it a promising therapeutic target in IBS.

Is orthorexia nervosa a hidden threat impacting quality of life in IBS patients?

BACKGROUNDS

The potential link between functional gastrointestinal disorders and eating disorders has been reported recently.

AIMS

The present study aimed to explore the relationship between orthorexic tendencies and irritable bowel syndrome (IBS)-related quality of life in IBS patients.

METHOD

This cross-sectional study was conducted with 121 IBS patients. The data were collected using Orthorexia Nervosa-11 (ORTO-11) to assess orthorexic tendencies, Irritable Bowel Syndrome Quality of Life Scale (IBS-QoL) to measure quality of life, and Irritable Bowel Syndrome Symptom Severity Score (IBS-SSS) to measure IBS symptoms. Food consumption record was taken to assess diet quality with the Healthy Eating Index 2015 (HEI-2015). The relationship between measured variables was assessed.

RESULTS

The mean ORTO-11 score of the patients was 24.76 ± 3.99. Most patients had poor diet quality (52.00%). A moderate positive correlation was found between ORTO-11 and IBS-QoL (model 0, p < 0.005 and model 1, p < 0.001) and a strong negative correlation between IBS-SSS and IBS-QoL (p < 0.001).

CONCLUSIONS

In conclusion, we can conclude that both altered IBS symptoms and orthorexic tendencies affect the quality of life of irritable bowel patients independently of each other. These findings provide valuable insights into the treatment of IBS and inform clinicians and researchers in the fields of gastroenterology, nutrition, psychiatry,and psychology.

Probiotics plus vitamin D in irritable bowel syndrome: a prospective multicentric non-interventional study

BACKGROUND

Patients with irritable bowel syndrome (IBS) experience recurrent symptoms and anxiety disorders that significantly impact their quality of life (QoL). The aim of the study was to assess in daily practice the benefit of the combination of three probiotic strains (Lactobacillus plantarum CETC 7484 and CETC 7485; Pediococcus acidilactici CECT 7483) plus vitamin D in patients with diarrhea-predominant IBS (IBS-D) or IBS with mixed bowel movements (IBS-M).

METHODS

This was a prospective, multicenter, non-interventional study in adult patients with IBS-D or IBS-M (Rome IV criteria) followed by private-practice gastroenterologists. Patients received daily one sachet of a combination of probiotics (3×109 CFU) and vitamin D (10 μg) for 42 days. The primary endpoint was the responder rate at D42 (≥50% and/or ≥100-point decrease of IBS-Severity Scoring System; IBS-SSS). Gut-related anxiety was measured with the Visceral Sensitivity Index (VSI).

RESULTS

The full analysis set population included 246 patients (mean age, 51.2±15.4 years; women, 73.2%; IBS-D, 56.1%; IBS-M, 43.9%). At D42, among the 89 patients with evaluable data, the responder rate was 62.9% with a mean decrease of IBS-SSS of 146.6±125.9 (P<0.0001). Changes of IBS-SSS were significantly correlated with changes of IBS-QoL (r=-0.78; P<0.0001), HAD-anxiety (r=0.46; P<0.0001), HAD-depression (r=0.61; P<0.001) and VSI (r=0.74; P<0.0001).

CONCLUSIONS

These real-life results are in line with a previous randomized clinical trial demonstrating the benefits of this combination in IBS-D and IBS-M. Symptom relief was associated with improvement of IBS-QoL, anxiety, depression and specifically gut-related anxiety.

Fecal Microbiota Characteristics in Constipation-Predominant and Mixed-Type Irritable Bowel Syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is a common condition that affects the lifestyle of patients. It is associated with significant changes in the composition of the gut microbiome, but the underlying microbial mechanisms remain to be fully understood. We study the fecal microbiome of patients with constipation-predominant IBS (IBS-C) and mixed-type IBS (IBS-M).

METHODS

We sequenced the V3 region of the 16S rRNA on the Ion Torrent PGM sequencing platform to study the microbiome.

RESULTS

In the patients with IBS-C and IBS-M, an increase in alpha diversity was found, compared to the healthy group, and differences in beta diversity were also noted. At the phylum level, both IBS subtypes showed an increase in the Firmicutes/Bacteroidetes ratio, as well as an increase in the abundance of Actinobacteria and Verrucomicrobiota. Changes in some types of bacteria were characteristic of only one of the IBS subtypes, while no statistically significant differences in the composition of the microbiome were detected between IBS-C and IBS-M.

CONCLUSIONS

This study was the first to demonstrate the association of Turicibacter sanguinis, Mitsuokella jalaludinii, Erysipelotrichaceae UCG-003, Senegalimassilia anaerobia, Corynebacterium jeikeium, Bacteroides faecichinchillae, Leuconostoc carnosum, and Parabacteroides merdae with IBS subtypes.

Immune cell signatures and causal association with irritable bowel syndrome: A mendelian randomization study

BACKGROUND

The mucosal barrier's immune-brain interactions, pivotal for neural development and function, are increasingly recognized for their potential causal and therapeutic relevance to irritable bowel syndrome (IBS). Prior studies linking immune inflammation with IBS have been inconsistent. To further elucidate this relationship, we conducted a Mendelian randomization (MR) analysis of 731 immune cell markers to dissect the influence of various immune phenotypes on IBS. Our goal was to deepen our understanding of the disrupted brain-gut axis in IBS and to identify novel therapeutic targets.

AIM

To leverage publicly available data to perform MR analysis on 731 immune cell markers and explore their impact on IBS. We aimed to uncover immunophenotypic associations with IBS that could inform future drug development and therapeutic strategies.

METHODS

We performed a comprehensive two-sample MR analysis to evaluate the causal relationship between immune cell markers and IBS. By utilizing genetic data from public databases, we examined the causal associations between 731 immune cell markers, encompassing median fluorescence intensity, relative cell abundance, absolute cell count, and morphological parameters, with IBS susceptibility. Sensitivity analyses were conducted to validate our findings and address potential heterogeneity and pleiotropy.

RESULTS

Bidirectional false discovery rate correction indicated no significant influence of IBS on immunophenotypes. However, our analysis revealed a causal impact of IBS on 30 out of 731 immune phenotypes (P < 0.05). Nine immune phenotypes demonstrated a protective effect against IBS [inverse variance weighting (IVW) < 0.05, odd ratio (OR) < 1], while 21 others were associated with an increased risk of IBS onset (IVW ≥ 0.05, OR ≥ 1).

CONCLUSION

Our findings underscore a substantial genetic correlation between immune cell phenotypes and IBS, providing valuable insights into the pathophysiology of the condition. These results pave the way for the development of more precise biomarkers and targeted therapies for IBS. Furthermore, this research enriches our comprehension of immune cell roles in IBS pathogenesis, offering a foundation for more effective, personalized treatment approaches. These advancements hold promise for improving IBS patient quality of life and reducing the disease burden on individuals and their families.

Atractylodes macrocephala Koidz Alleviates Symptoms in Zymosan-Induced Irritable Bowel Syndrome Mouse Model through TRPV1, NaV1.5, and NaV1.7 Channel Modulation

(1) Background: Irritable bowel syndrome (IBS) is a common disease in the gastrointestinal (GI) tract. Atractylodes macrocephala Koidz (AMK) is known as one of the traditional medicines that shows a good efficacy in the GI tract. (2) Methods: We investigated the effect of AMK in a network pharmacology and zymosan-induced IBS animal model. In addition, we performed electrophysiological experiments to confirm the regulatory mechanisms related to IBS. (3) Results: Various characteristics of AMK were investigated using TCMSP data and various analysis systems. AMK restored the macroscopic changes and weight to normal. Colonic mucosa and inflammatory factors were reduced. These effects were similar to those of amitriptyline and sulfasalazine. In addition, transient receptor potential (TRP) V1, voltage-gated Na+ (NaV) 1.5, and NaV1.7 channels were inhibited. (4) Conclusion: These results suggest that AMK may be a promising therapeutic candidate for IBS management through the regulation of ion channels.

Risk Factors of Developing Postinfectious Irritable Bowel Syndrome in Shigellosis Patients, 5 Years After Hospitalization During the Outbreak

Background

Irritable bowel syndrome (IBS) can be triggered by bacterial dysentery. This study aimed to investigate postinfectious IBS and its risk factors after the shigellosis outbreak in hospitalized patients.

Methods

This retrospective study was conducted in 2020-2021 in referral hospitals for Shigella gastroenteritis during the 2014 shigellosis outbreak in Isfahan. The Shigella-infected group included hospitalized shigellosis patients with clinical symptoms and positive stool culture. The control group included patients matched pairwise on age and sex to the Shigella-infected group, admitted to the same hospitals in the same period with diagnoses other than shigellosis. Both groups had no history of diagnosed IBS before the outbreak. The incidence of IBS (according to Rome-III criteria) and its related factors was compared between the 2 groups 5 years after infection.

Results

Of 619 participants, 220 (35.5%) were in the Shigella-infected group. The 5-year incidence of IBS was 31.8% and 5.7% in the Shigella-infected and control groups, respectively. Multivariate analysis showed that shigellosis was significantly associated with increased risk of IBS (odds ratio [OR], 17.18 [95% confidence interval {CI}, 9.37-31.48]). Multivariate analysis indicated education level (OR, 4.15 [95% CI, 1.47-11.73]), diarrhea lasting >4 days (OR, 1.69 [95% CI, 1.17-2.44]), and abdominal cramps during the infection (OR, 0.27 [95% CI, .77-.95]) associated with postinfectious IBS (P < .05).

Conclusions

Hospitalized patients with Shigella gastroenteritis are at increased risk of IBS within 5 years after infection. Factors such as higher education level and the absence of abdominal cramps and diarrhea persisting for >5 days during hospitalization can further increase this risk.

Integrated Virtual Care for Irritable Bowel Syndrome: A Qualitative Study

Irritable bowel syndrome (IBS) is a condition that affects approximately one in 10 people in the United States (Defrees & Bailey, 2017). Despite the high prevalence of IBS, the medical community struggles to effectively understand, diagnose, and treat this disorder (Ankersen et al., 2021). In recent years, an increasing number of health-tech companies have emerged to offer integrated treatment of IBS via telemedicine. This pilot study explores the patient experience of virtual, multidisciplinary IBS care through a U.S.-based company, Oshi Health. Semistructured interviews were conducted followed by thematic analysis to identify commonalities between patient experience and perspective (Van Manen, 2014). Overarching themes were identified as follows: loss of the grocer, a broken system, and the power of self-trust. Although several limitations exist, including small sample size, the study offers insight into the experience of telemedicine services for IBS and provides a framework for future research.

The Role of Diet in the Management of Irritable Bowel Syndrome: A Comprehensive Review

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder that has a significant impact on the general population. The suboptimal medical treatments available for IBS contribute to its large economic burden. The pathophysiology of IBS is complex, and treatments often focus on managing specific symptoms. Many individuals with IBS associate their symptoms with specific food intake, leading to increased scientific research on the role of diet in managing IBS. Dietary management has become a crucial aspect of IBS treatment, with initial recommendations focusing on adopting a healthy eating pattern and lifestyle. This comprehensive review aims to synthesise the current literature on the impact of diet on IBS, exploring various dietary approaches to managing IBS, including the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, gluten-free diet, Mediterranean diet, and tritordeum-based diet. It presents evidence from both experimental and observational studies and summarises the underlying dietary triggers in IBS, including gut microbiota dysbiosis, visceral hypersensitivity, and immune activation. In addition, it explores the efficacy and limitations of the key diet and lifestyle recommendations provided by dietary guidelines and scientific literature, highlighting the importance of individualised dietary strategies tailored to the unique needs of different types of IBS patients. By elucidating the complex interplay between diet and IBS pathophysiology, this review provides valuable insights into optimising dietary management approaches for improving symptom control and enhancing the quality of life for individuals with IBS.

[Familial aggregation in Irritable Colon Syndrome in Mexican patients. A case-control study]

OBJECTIVE

To determine a family aggregation pattern of Irritable Bowel Syndrome (IBS).

DESIGN

it is a case-control study with a 1.2 ratio.

SETTING

External consultation of a general family medicine practice.

PARTICIPANTS

men and women from 18 to 60 years old. Cases (40): people with IBS according to the Rome IV criteria, and Controls (80): relatives without gastrointestinal disease.

MAIN MEASUREMENTS

Sociodemographic variables, related stressful events, predominant evacuation patterns, and family repetition patterns for IBS. Data were analyzed with descriptive and inferential statistics. Chi-square for categorical data (< p.05 as significant) estimate of ORs with 95% confidence interval. The institutional ethics committee approved it.

RESULTS

The IBS presentation pattern was repeated in relatives, mainly first-degree. The risk of suffering from IBS was higher when the father reported it (OR 11.2 (95% CI; 1.2 -100.1), than the mother OR 3,7 (95% CI; 1.4 - 9.9), sibling OR 2.8 (95% CI; 1.1 - 6.6. In both groups, the relative who most frequently presented IBS was in the collateral line (sibling) (37.5% in cases vs. 17.5% in controls (p=0.023). In both groups, the predominant gender was female, with 80. 0% in cases and 57.5% in controls.

CONCLUSION

SII has a familial recurrence pattern in the Mexican population. The disease is more frequent in first-degree relatives. It is important to elucidate the importance of the role that plays genetic background vs. the influence of the family environment in SII.

Comparison of the Effectiveness of Mindfulness-Based Stress Reduction and Compassion-Focused Treatment on the Severity of Gastrointestinal Symptoms in Patients with Irritable Bowel Syndrome

Background

The aim of this research was to compare the effectiveness of mindfulness-based stress reduction and compassion-focused on the severity of digestive symptoms in patients with irritable bowel syndrome (IBS).

Methods

The research method was of semi-experimental type with pre-test, post-test, follow-up, and experimental and control groups. The population included patients with IBS in Isfahan city, 45 of them were selected by convenience sampling method and randomly assigned to three groups (15 in each group). Then, the patients of one experimental group received eight sessions of 90 minutes of a mindfulness-based stress reduction program, while the other experimental group received eight sessions of 90 minutes of compassion-focused therapy. The measurement tools included the severity of IBS scale and a short clinical interview. Research data were analyzed using variance analysis with repeated measures on one factor (mixed design).

Results

The results showed that both methods of intervention had been equally effective on the severity of disease symptoms (P<0.01).

Conclusion

Both intervention methods can be used as a complementary treatment for patients with IBS.

[Method of manual-physical correction in the treatment of hypertensive disease and normalization of psychoneurological status in patients with degenerative-dystrophic processes of the musculoskeletal system]

There are some non-communicable diseases (NCD) associated with arterial hypertension (AHT) that are cured after recovery from AHT. Recently confirmed the theory of centralized aerobic-anaerobic energy balance compensation (TCAAEBC) originated some NCDs with the obstructions of arterial blood flow access to the rhomboid fossa. For some sergeants, this has already been demonstrated. Since neurological NCDs are similarly considered by TCAAEBC, it is logical to analyze dynamics of such musculoskeletal neurological problem as isolated musculoskeletal chest pain (IMCP) in connection with the therapy based on TCAAEBC. We retrospectively evaluated the medical records of adult patients with AHT, simultaneously suffering from IMCP. All these patients underwent complex treatment including manual techniques that restore arterial blood flow to the rhomboid fossa, followed by therapy that strengthens the muscular corset primarily of the cervical region. This, in addition to the normalization of AHT, led to a decrease in the musculoskeletal pain syndrome. The dynamic of pain was recorded according to four questionaries - Oswestry Disability Index (ODI) Hospital Anxiety and Depression Scale (HADS), Numerical Rating Scale (NRS), and the Quality-of-life assessment questionnaire (SF-12). The collected data were analyzed with the Wilcoxon signed-rank test, which confirms the recovery of the patients from both AHT and IMCP.

The Role of Nutraceutical Supplements in the Treatment of Irritable Bowel Syndrome: A Mini Review

BACKGROUND

Irritable bowel syndrome (IBS) is a prolonged bowel illness that is generally stress-related and is characterized by a variety of gastrointestinal problems, the most prominent of which is chronic visceral abdominal discomfort. As a result, IBS typically impacts sufferers' standard of living, and it is typically associated with depression and anxiety symptoms. IBS medication is based mostly on symptom alleviation. However, no effective medicines have been discovered too far. As a result, it is essential to discover novel anti-IBS medications.

OBJECTIVE

The purpose of this brief review is to describe the existing research on nutraceutical supplements in irritable bowel syndrome management, including probiotics, prebiotics, symbiotics, herbal products, and dietary fibers.

METHODS

This review covered the relevant papers from the previous twenty years that were available in different journals such as Science Direct, Elsevier, NCBI, and Web of Science that were related to the role and function of nutraceuticals in Irritable Bowel Syndrome.

RESULTS

Nutraceutical substances have a variety of modes of action, including restoring the healthy microbiome, improving the function of the gastrointestinal barrier, immunomodulatory, antiinflammatory, and antinociceptive properties. According to the literature, these substances not only can improve irritable bowel syndrome symptomatology but also have an excellent long-term safety profile.

CONCLUSION

Irritable bowel syndrome is a prolonged bowel illness with a lot of gastrointestinal problems. The nutraceuticals treatment works as an anti-IBS intervention and enhances patient compliance with minimum side effects since patients take it better than pharmaceutical treatments.

Subtyping irritable bowel syndrome using cluster analysis: a systematic review

BACKGROUND

Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder associated with a wide range of clinical symptoms. Some researchers have used cluster analysis (CA), a group of non-supervised learning methods that identifies homogenous clusters within different entities based on their similarity.

OBJECTIVE AND METHODS

This literature review aims to identify published articles that apply CA to IBS patients. We searched relevant keywords in PubMed, Embase, Web of Science, and Scopus. We reviewed studies in terms of the selected variables, participants' characteristics, data collection, methodology, number of clusters, clusters' profiles, and results.

RESULTS

Among the 14 articles focused on the heterogeneity of IBS, eight of them utilized K-means Cluster Analysis (K-means CA), four employed Hierarchical Cluster Analysis, and only two studies utilized Latent Class Analysis. Seven studies focused on clinical symptoms, while four articles examined anocolorectal functions. Two studies were centered around immunological findings, and only one study explored microbial composition. The number of clusters obtained ranged from two to seven, showing variation across the studies. Males exhibited lower symptom severity and fewer psychological findings. The association between symptom severity and rectal perception suggests that altered rectal perception serves as a biological indicator of IBS. Ultra-slow waves observed in IBS patients are linked to increased activity of the anal sphincter, higher anal pressure, dystonia, and dyschezia.

CONCLUSION

IBS has different subgroups based on different factors. Most IBS patients have low clinical severity, good QoL, high rectal sensitivity, delayed left colon transit time, increased systemic cytokines, and changes in microbial composition, including increased Firmicutes-associated taxa and depleted Bacteroidetes-related taxa. However, the number of clusters is inconsistent across studies due to the methodological heterogeneity. CA, a valuable non-supervised learning method, is sensitive to hyperparameters like the number of clusters and random initialization of cluster centers. The random nature of these parameters leads to diverse outcomes even with the same algorithm. This has implications for future research and practical applications, necessitating further studies to improve our understanding of IBS and develop personalized treatments.

Therapeutic effects of curcumin on constipation-predominant irritable bowel syndrome is associated with modulating gut microbiota and neurotransmitters

Introduction

Constipation-predominant irritable bowel syndrome (IBS-C) is a functional bowel disease that affects 10-20% of the population worldwide. Curcumin (CUR) is widely used in traditional Chinese medicine to treat IBS, but its mechanism of action needs further investigation.

Methods

In this study, we used mosapride (MOS) as a positive control to evaluate the changes in gut microbiota in IBS-C rat models after treatment with CUR or MOS by analyzing 16S rDNA variation. In addition, we used enzyme immunoassay kits and immunohistochemical analysis to investigate whether CUR or MOS influenced serotonin (5-HT), substance P (SP), and vasoactive intestinal peptide (VIP) levels in the serum and colon of IBS-C rats.

Results

The study showed that rats supplemented with CUR showed significantly increased fecal weight, fecal water content, small intestine transit rate and significantly decreased serum levels of 5-HT, VIP and SP compared to the IBS group (p < 0.05). In addition, treatment with CUR changed the relative abundance of Blautia, Sutterella, Acetanaerobacterium and Ruminococcus2 in the gut microbiota.

Discussion

This study showed that the efficacy of CUR on IBS-C was possibly by modulating the microbiota and lowering the serum levels of HT, SP, and VIP.

Insights into the Characteristics and Functions of Mast Cells in the Gut

Mast cells have vital functions in allergic responses and parasite ejection, while the underlying mechanisms remain unclear. Meanwhile, MCs are essential for the maintenance of GI barrier function, and their interactions with neurons, immune cells, and epithelial cells have been related to various gastrointestinal (GI) disorders. An increasing number of investigations are being disclosed, with a lack of inner connections among them. This review aims to highlight their properties and categorization and further delve into their participation in GI diseases via interplay with neurons and immune cells. We also discuss their roles in diseases like inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Based on the evidence, we advocated for their potential application in clinical practices and advocated future research prospects.

Clinical Characteristics and Treatment of Irritable Bowel Syndrome in a Colombian Population: A Cross-Sectional Study

BACKGROUND

Irritable bowel syndrome (IBS) is a functional disorder that leads to abdominal pain; its diagnosis is based on Rome IV criteria (recurrent abdominal pain at least 1 day per week in the last 3 months with more than two of the following: related to defecation, associated with a change in stool frequency and/or with a change in stool appearance).

OBJECTIVE

To characterize an outpatient population diagnosed with IBS in Colombia during 2017-2018.

METHODS

A cross-sectional study based on a review of clinical records of patients with a primary diagnosis of IBS. A representative sample of 380 individuals was recruited from a population of 38,182 people with a new diagnosis of IBS from a drug-claim database. Sociodemographic, clinical (symptoms, type of IBS, alarm features, etc.), treatment (pharmacological or not), and follow-up variables (for those with additional medical care at 3-12 months) were analyzed. The diagnosis and treatment used in the consultation were compared with clinical guidelines.

RESULTS

Most of the 380 patients were women (n = 238; 62.6%), and the mean age was 40.1 ± 15.0 years. None of the physicians recorded the Rome IV criteria in the medical records. Unclassified IBS was the most prevalent subtype (n = 311; 81.8%), and the main symptom was abdominal pain (n = 327; 86.1%). Only 73 patients (19.2%) had follow-up data. The most frequently used drugs were aluminum hydroxide (n = 203; 53.4%) and hyoscine N-butyl bromide (n = 200; 52.6%). Regarding drugs included in the clinical practice guidelines, 19 people received loperamide (5.0%), 3 received trimebutine (0.8%), and 1 received sertraline (0.3%).

CONCLUSIONS

The patients were diagnosed without clearly established criteria, and they were treated symptomatically with little follow-up.

Transcutaneous electrical stimulation for gastrointestinal motility disorders

BACKGROUND/PURPOSE

Gastrointestinal (GI) dysmotility is categorized by muscle or nerve dysfunctions in any portion of the GI tract, which leads to abnormalities in GI motor and sensory function. Symptoms may vary depending on the organ affected and can be debilitating. Treatment usually involves diet and lifestyle changes. Pharmacotherapy is limited in effectiveness with various side effects. Transcutaneous electrical stimulation (TES), a noninvasive, needleless technique that provides electrical stimulation using cutaneous non-needle electrodes, has become increasingly popular. It has been shown to be beneficial in treating GI motility disorders.

METHODS

This review paper navigates through the different TES techniques, including transcutaneous peripheral nerve (vagal/sacral/tibial nerves) electrical stimulation, transcutaneous electrical acustimulation (stimulation via acupuncture point), transcutaneous interferential current therapy, and transcutaneous electrical nerve stimulation.

KEY RESULTS

As we delve deeper, we explore the promising effects of TES on dysphagia, gastroesophageal reflux disease, functional dyspepsia, gastroparesis, postoperative ileus, constipation, and irritable bowel syndrome. The literature at hand speaks volumes about the therapeutic prowess of this noninvasive technique.

CONCLUSION & INFERENCES

The time is ripe to evaluate further the full therapeutic potential of TES, a noninvasive, nonpharmaceutical, nonsurgical, and home-based self-administrative technique in managing GI motility disorders.

The prevalence and risk factors of irritable bowel syndrome (PRIBS study) among adults in low- and middle-income countries: A multicenter cross-sectional study

Background and Aims

Because of the plenty and abundance of risk factors and the expected increase in the prevalence of irritable bowel syndrome (IBS) in the world in general and in low- and middle-income countries in particular, this international cross-sectional study was conducted in 15 low- and middle-income countries according to our previous protocol, NCT05340400.

Methods

Participants were recruited in the period from April 22, 2022 to June 14, 2022. The diagnosis of IBS was according to ROME IV. We determined the physical activity, daily stress, and fatigue of the participants. A large number of collaborators were chosen from different regions and institutions within each country to achieve diversity within the sample and reduce the probability of bias.

Results

The prevalence of IBS appears to be higher in low- and middle-income countries (mean = 25.2%, range [6.2%-44.2%]) than in high-income countries, with a higher prevalence among Africans than Caucasians and Asians. The prevalence of IBS increased in the fourth decade by 32.1% and in the fifth decade by 31.1% (p-value < 0.001). In addition to the previously known risk factors for IBS such as female sex, smoking, psychological stress, and chronic fatigue, other risk factors were discovered such as chronic diseases, including high blood pressure and diabetes, allergies to some substances, previous infection with COVID-19, and the participant having a first-degree relative with a patient. There are also some other modifiable risk factors, such as an abnormal body mass index (whether high or low), smoking, a protein- or fat-rich diet, drinking caffeine-containing beverages, and poor physical activity.

Conclusions

Highlighting the prevalence and increasing risk factors of IBS in developing countries should draw the attention of those responsible for health care in these countries and reduce the risk factors.

Systematic review with meta-analysis: Stress-management interventions for patients with irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder of unknown pathological origin that is associated with psychological distress and reduced health-related quality of life (HRQoL). We investigated the effects of stress-management for adults with IBS on typical symptoms, HRQoL and mental health. With predefined criteria (patients: adults with IBS; intervention: stress-management; control: care as usual or waitlist; outcome: patient-relevant; study-type: controlled trials), we registered the study with PROSPERO (168030) and searched the main medical databases. Two researchers independently reviewed the publications and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network checklist. We performed meta-analysis with homogeneous trials of acceptable quality. After screening 6656 publications, ten suitable randomized trials of acceptable (n = 5) or low methodological quality (n = 5) involving 587 patients were identified. Our meta-analysis showed no effect of stress-management on IBS severity 1-2 months after the intervention (Hedges' g = -0.23, 95%-CI = -0.84 to -0.38, I2  = 86.1%), and after 3-12 months (Hedges' g = -0.77, 95%-CI = -1.77 to -0.23, I2  = 93.3%). One trial found a short-term reduction of symptoms, and one trial found symptom relief in the long-term (at 6 months). One of two studies that examined HRQoL found an improvement (after 2 months). One of two studies that examined depression and anxiety found a reduction of these symptoms (after 3 weeks). Stress-management may be beneficial for patients with IBS regarding the short-term reduction of bowel and mental health symptoms, whereas long-term benefits are unclear. Good quality RCTs with more than 6 months follow-up are needed.

HLA-DQ and alcohol in the pathogenesis of irritable bowel syndrome in college students: a case-control study

Some researchers have shown that genetics contribute to the incidence of IBS. However, no research has focused on the interaction between HLA-DQ and living habits in the pathogenesis of IBS. The present study explored the risk factors for IBS in college students of Guangxi Han nationality and explored the interaction between HLA-DQ and living habits on the pathogenesis of IBS. Univariate and multivariate analyses were used to determine the risk factors for IBS. Logistic interaction analysis and the Excel table made by Andersson were used to explore the interaction between genes and living habits in the context of IBS. We found that low expression of HLA-DQ2 and DQ8 were associated with the pathogenesis of IBS, while mild to moderate alcohol consumption was associated with the occurrence of IBS symptoms. Only the HLA-DQ8 gene and alcohol consumption had additive interactions in the context of the occurrence of IBS. In other words, for college students of Guangxi Han nationality, HLA-DQ2 and HLA-DQ8 might be protective against IBS, while alcohol consumption might be an independent risk factor. There was an additive interaction between HLA-DQ8 and alcohol consumption in the occurrence of IBS.

Irritable Bowel Syndrome: Treating the Gut and Brain/Mind at the Same Time

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal (GI) disorders in the world. Although IBS does not affect a person's life span, it can significantly influence their quality of life. The treatment of IBS should be tailored to each patient's specific symptomatology because it can often be difficult to manage. Given that the pathogenesis of IBS is not well understood, it places a tremendous load on healthcare resources. Over the years, IBS has been described as either a simple GI disorder or a more complex multi-symptomatic gut-brain axis disorder. Many persons with IBS have psychological issues in addition to gastrointestinal symptoms, offering the door to non-pharmacological therapies such as cognitive behavioral therapy, gut-directed hypnosis, or psychodynamic interpersonal therapy. Non-pharmacological therapies with no side effects should be used as first-line therapy. Diet, exercise, microbiota-targeted therapies, and psychological treatments are among the most significant interventions. This review goes into the details of all the non-pharmacological interventions that can be used to treat IBS.

miR-1306-3p directly activates P2X3 receptors in primary sensory neurons to induce visceral pain in rats

ABSTRACT

Mounting evidence indicates that microRNAs (miRNAs) play critical roles in various pathophysiological conditions and diseases, but the physiological roles of extracellular miRNAs on the disease-related ion channels remain largely unknown. Here, we showed that miR-1306-3p evoked action potentials and induced inward currents of the acutely isolated rat dorsal root ganglion (DRG) neurons. The miR-1306-3p-induced effects were significantly inhibited by A317491, a potent inhibitor of the P2X3 receptor (P2X3R), or disappeared after the knockdown of P2X3Rs in DRG neurons. We further identified R180, K315, and R52 as the miR-1306-3p interaction sites on the extracellular domain of P2X3Rs, which were distinct from the orthosteric ATP-binding sites. Intrathecal injection of miR-1306-3p produced visceral pain but not somatic pain in normal control rats. Conversely, intrathecal application of a miR-1306-3p antagomir and A317491 significantly alleviated visceral pain in a rat model of chronic visceral pain. Together, our findings suggest that miR-1306-3p might function as an endogenous ligand to activate P2X3Rs, eventually leading to chronic visceral pain.

Role of Vagus Nerve Stimulation in the Treatment of Chronic Pain

Vagus nerve stimulation (VNS) can modulate vagal activity and neuro-immune communication. Human and animal studies have provided growing evidence that VNS can produce analgesic effects in addition to alleviating refractory epilepsy and depression. The vagus nerve (VN) projects to many brain regions related to pain processing, which can be affected by VNS. In addition to neural regulation, the anti-inflammatory property of VNS may also contribute to its pain-inhibitory effects. To date, both invasive and noninvasive VNS devices have been developed, with noninvasive devices including transcutaneous stimulation of auricular VN or carotid VN that are undergoing many clinical trials for chronic pain treatment. This review aimed to provide an update on both preclinical and clinical studies of VNS in the management for chronic pain, including fibromyalgia, abdominal pain, and headaches. We further discuss potential underlying mechanisms for VNS to inhibit chronic pain.

Efficacy of Different Dietary Patterns in the Treatment of Functional Gastrointestinal Disorders in Children and Adolescents: A Systematic Review of Intervention Studies

Functional gastrointestinal disorders (FGIDs) are common in children and adolescents. In recent years, interest in the role of diet in the treatment of FGIDs has increased. Currently, interest focuses on the low-FODMAP diet (LFD), the fructose- or lactose-restricted diet (FRD or LRD), the gluten-free diet (GFD), and the Mediterranean diet (MD). In this review, we focus on the role of these dietary patterns in the FGIDs most commonly diagnosed in clinical practice, namely irritable bowel syndrome (IBS), functional abdominal pain (FAP), functional dyspepsia (FD), and functional constipation (FC). Fifteen clinical trials were systematically reviewed (both RCTs and single-arm clinical trials). We demonstrated the lack of high-quality intervention trials. Based on current evidence, low-FODMAP diet, LRD, FRD, and GFD have no place in daily clinical practice for the management of children and adolescents with FGIDs. Nevertheless, some patients with IBS or RAP may experience some benefit from the use of a low-FODMAP diet or FRD/LRD. Limited data suggest that MD may be promising in the management of FGIDs, especially in IBS patients, but more data are required to investigate the mechanisms of its protective effects.

Combined GWAS and single cell transcriptomics uncover the underlying genes and cell types in disorders of gut-brain interaction

Disorders of gut-brain interaction (DGBIs), formerly known as functional gastrointestinal disorders, are extremely common and historically difficult to manage. This is largely because their cellular and molecular mechanisms have remained poorly understood and understudied. One approach to unravel the molecular underpinnings of complex disorders such as DGBIs is performing genome wide association studies (GWASs). However, due to the heterogenous and non-specific nature of GI symptoms, it has been difficult to accurately classify cases and controls. Thus, to perform reliable studies, we need to access large patient populations which has been difficult to date. Here, we leveraged the UK Biobank (UKBB) database, containing genetic and medical record data of over half a million individuals, to perform GWAS for five DGBI categories: functional chest pain, functional diarrhea, functional dyspepsia, functional dysphagia, and functional fecal incontinence. By applying strict inclusion and exclusion criteria, we resolved patient populations and identified genes significantly associated with each condition. Leveraging multiple human single-cell RNA-sequencing datasets, we found that the disease associated genes were highly expressed in enteric neurons, which innervate and control GI functions. Further expression and association testing-based analyses revealed specific enteric neuron subtypes consistently linked with each DGBI. Furthermore, protein-protein interaction analysis of each of the disease associated genes revealed protein networks specific to each DGBI, including hedgehog signaling for functional chest pain and neuronal function and neurotransmission for functional diarrhea and functional dyspepsia. Finally, through retrospective medical record analysis we found that drugs that inhibit these networks are associated with an increased disease risk, including serine/threonine kinase 32B drugs for functional chest pain, solute carrier organic anion transporter family member 4C1, mitogen-activated protein kinase 6, and dual serine/threonine and tyrosine protein kinase drugs for functional dyspepsia, and serotonin transporter drugs for functional diarrhea. This study presents a robust strategy for uncovering the tissues, cell types, and genes involved in DGBIs, presenting novel predictions of the mechanisms underlying these historically intractable and poorly understood diseases.

Deciphering chemical and metabolite profiling of Chang-Kang-Fang by UPLC-Q-TOF-MS/MS and its potential active components identification

Chang-Kang-Fang (CKF) formula, a Traditional Chinese Medicine (TCM) prescription, has been widely used for the treatment of irritable bowel syndrome (IBS). However, its potential material basis and underlying mechanism remain elusive. Therefore, this study employed an integrated approach that combined ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q/TOF-MS) with network pharmacology to systematically characterize the phytochemical components and metabolites of CKF, as well as elucidating its underlying mechanism. Through this comprehensive analysis, a total of 150 components were identified or tentatively characterized within the CKF formula. Notably, six N-acetyldopamine oligomers from CicadaePeriostracum and eight resin glycosides from Cuscutae Semen were characterized in this formula for the first time. Meanwhile, 149 xenobiotics (58 prototypes and 91 metabolites) were detected in plasma, urine, feces, brain, and intestinal contents, and the in vivo metabolic pathways of resin glycosides were elaborated for the first time. Furthermore, network pharmacology and molecular docking analyses revealed that alkaloids, flavonoids, chromones, monoterpenes, N-acetyldopamine dimers, p-hydroxycinnamic acid, and Cus-3/isomer might be responsible for the beneficial effects of CKF in treating IBS, and CASP8, MARK14, PIK3C, PIK3R1, TLR4, and TNF may be its potential targets. These discoveries offer a comprehensive understanding of the potential material basis and clarify the underlying mechanism of the CKF formula in treating IBS, facilitating the broader application of CKF in the field of medicine.

McKittrick-Wheelock syndrome: A rare cause of chronic diarrhea treated with endoscopic polypectomy

Chronic diarrhea is a commonly encountered complaint and a principal cause of health care utilization worldwide. Although there are various etiologies of chronic diarrhea, McKittrick-Wheelock syndrome is a rare syndrome defined as a large villous adenoma with secretory diarrhea causing severe fluid imbalances. We report a case of a patient with McKittrick-Wheelock syndrome who was successfully treated with endoscopic resection. Our case aims to add information to the current literature supporting the endoscopic management of McKittrick-Wheelock syndrome.

Evaluation of the Symptom-Based Diagnostic Criteria for Irritable Bowel Syndrome in Conjunction With Clinical Examinations and Laboratory Investigations

Background Irritable bowel syndrome (IBS) is a chronic condition characterized by persistent abdominal pain or discomfort and impaired bowel function. Symptoms often vary in onset and severity, are worse during flare-ups, and affect the patient's quality of life. A positive diagnosis of IBS based on clinical symptoms may lead to a better outcome. There are different diagnostic criteria like Kruis score, Manning criteria, Rome I, II, III, and IV criteria, and each new one addresses the deficiencies of the previous ones. We analyze the effectiveness of the most commonly used diagnostic criteria associated with clinical examinations and laboratory tests in treating IBS in these studies. Methodology This is a retrospective study in which data from IBS subjects were collected by simple random sampling and compared using Manning criteria, Kruis score, and Rome IV criteria. Laboratory tests included complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Results Of the 130 patients, IBS is more prevalent in adults aged 30-50 years, with a male predominance. The Kruis score outperformed the Manning criterion in distinguishing between organic bowel disease and IBS. This, together with the Rome IV criteria, increases the likelihood of identifying IBS. Conclusions Differentiating IBS from functional and organic gastrointestinal problems is critical. Irritable bowel syndrome can be diagnosed using symptom-based diagnostic criteria. Clinical observation and physical examination should be supplemented with laboratory indicators.

Evaluation of Short Chain Fatty Acids (SCFAs) intestinal absorption, following digestion and fermentation of a novel medical device containing partially-hydrolyzed Guar gum plus simethicone

Irritable Bowel Syndrome (IBS) is a common disease characterized by alternate symptoms (diarrhea and constipation) and intestinal gas overproduction. A new medical device (Fibergone®), containing Partially Hydrolyzed Guar Gum (PHGG) and Simethicone (SM) has been proposed for managing patients with bowel disorders. PHGG acts also as a prebiotic so increasing the Short-Chain Fatty Acid (SCFA) production, useful for intestinal physiology. This in vitro study investigated the effects exerted by PHGG+SM on SCFA production and their intestinal absorption following in vitro digestive process and fermentation model. An in vitro model evaluated the digestive process and fermentation using simulated digestive fluids and a human intestinal epithelium in vitro model derived from based on intestinal adenocarcinoma Caco-2 cells (ATCC, HTB-37TM) and organized as a functional monolayer on Transwell® inserts. PHGG+SM was added in experiments and compared with a control (non-treated). SCFA production and absorption were assessed. Viability and barrier integrity of the intestinal epithelium model were also evaluated. PHGG+SM significantly (p<0.05) increased SCFAs content after fermentation, indicating that this medical device is effectively fermented at the large intestine level. However, in relation to SCFAs bioavailability, their absorption did not increase compared to the non-treated condition in the light of the physiological contribution of SCFAs resulting from the microflora. PHGG+SM did not affect intestinal epithelium apparent permeability (Papp) and viability. This in vitro study documented that partially hydrolyzed guar gum combined with simethicone significantly affects short-chain fatty acids production and consequently could be fruitfully employed in managing patients with intestinal disorders.

Sexual dysfunction worsens both the general and specific quality of life of women with irritable bowel syndrome. A cross-sectional study

BACKGROUND

Irritable bowel syndrome (IBS) and sexual dysfunction (SxD) lowers quality of life (QOL) separately, but the effect of their overlap in unselected populations has not been studied.

OBJECTIVE

To evaluate the QOL of IBS women with and without SxD and compare it with controls.

METHODS

In this cross-sectional assessment, we studied 51 IBS women (Rome IV criteria) and 54 controls. SxD was determined using the female sexual function index questionnaire. QOL was evaluated by the Short Form 36 (SF-36) and IBS-QOL questionnaires.

RESULTS

SxD prevalence was similar between IBS women (39.22%) and controls (38.89%). Compared with other groups, IBS patients with SxD showed lower scores in all domains as well as in the physical, mental summaries of the SF-36 and almost all domains (except for body image, food avoidance, and social reaction compared with IBS patients without SxD) and the total score of IBS-QOL.

CONCLUSIONS

These findings show that SxD worsens both general and specific QOL of women with IBS. The consideration of SxD in patients with IBS will allow us to make a more effective diagnostic and therapeutic approach. Clinical trial registry in Mexico City General Hospital: DI/19/107/03/080.

CLINICAL TRIALS REGISTRATION

NCT04716738.

Efficacy of a new nutraceutical formulation: L-tryptophan, probiotics, charcoal, chamomile, mint, and licorice (COLONIR®) in the improvement of gastrointestinal symptoms in subjects with irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders. IBS is characterized by recurrent chronic abdominal pain and altered bowel habits in the absence of organic damage. Although there are reviews and guidelines for treating IBS, the complexity and diversity of IBS presentation make treatment difficult. Treatment of IBS focuses on relieving symptoms as mild signs and symptoms can often be controlled by managing stress and by making changes in diet and lifestyle. The use of nutraceutical compounds has been advocated as a possible alternative treatment in patients with IBS. COLONIR® (Omega Pharma Srl, Milan, Italy) may be an alternative or adjuvant treatment in patients with gastrointestinal symptoms. This study aimed to evaluate the effect of this new nutraceutical formulation in inducing symptoms remission and improve gastrointestinal habits.

METHODS

An initial cohort of 1004 consecutive patients referred to 25 different Units of Internal Medicine a/o Gastroenterology in Italy to perform colonoscopy for intestinal symptoms was asked to participate. Patients were treated for 2 months with two doses of nutraceuticals/day during meals namely COLONIR®. Patients were assessed at baseline and after 2 months to evaluate the frequency and severity of gastrointestinal symptoms in the past seven days with a questionnaire based on ROMA IV criteria.

RESULTS

After 2 months, 899 patients completed the follow-up. COLONIR® achieved a statistically significant reduction of severity of symptoms in the study population without any documented side effects.

CONCLUSIONS

These promising results, here reported, need to be confirmed, valuating the efficacy of COLONIR® in relieving gastrointestinal symptoms in IBS patients in further studies.

Practicing Digital Gastroenterology through Phonoenterography Leveraging Artificial Intelligence: Future Perspectives Using Microwave Systems

Production of bowel sounds, established in the 1900s, has limited application in existing patient-care regimes and diagnostic modalities. We review the physiology of bowel sound production, the developments in recording technologies and the clinical application in various scenarios, to understand the potential of a bowel sound recording and analysis device-the phonoenterogram in future gastroenterological practice. Bowel sound production depends on but is not entirely limited to the type of food consumed, amount of air ingested and the type of intestinal contractions. Recording technologies for extraction and analysis of these include the wavelet-based filtering, autoregressive moving average model, multivariate empirical mode decompression, radial basis function network, two-dimensional positional mapping, neural network model and acoustic biosensor technique. Prior studies evaluate the application of bowel sounds in conditions such as intestinal obstruction, acute appendicitis, large bowel disorders such as inflammatory bowel disease and bowel polyps, ascites, post-operative ileus, sepsis, irritable bowel syndrome, diabetes mellitus, neurodegenerative disorders such as Parkinson's disease and neonatal conditions such as hypertrophic pyloric stenosis. Recording and analysis of bowel sounds using artificial intelligence is crucial for creating an accessible, inexpensive and safe device with a broad range of clinical applications. Microwave-based digital phonoenterography has huge potential for impacting GI practice and patient care.

Stroke and the risk of gastrointestinal disorders: A Mendelian randomization study

Background

The issue of whether a stroke is causally related to gastrointestinal disorders was still not satisfactorily understood. Therefore, we investigated if there is a connection between stroke and the most prevalent gastrointestinal disorders, including peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD).

Methods

We applied two-sample Mendelian randomization to investigate relationships with gastrointestinal disorders. We obtained genome-wide association study (GWAS) summary data of any stroke, ischemic stroke, and its subtypes from the MEGASTROKE consortium. From the International Stroke Genetics Consortium (ISGC) meta-analysis, we acquired GWAS summary information on intracerebral hemorrhage (ICH), including all ICH, deep ICH, and lobar ICH. Several sensitivity studies were performed to identify heterogeneity and pleiotropy, while inverse-variance weighted (IVW) was utilized as the most dominant estimate.

Results

No evidence for an effect of genetic predisposition to ischemic stroke and its subtypes on gastrointestinal disorders were found in IVW. The complications of deep ICH are a higher risk for PUD and GERD. Meanwhile, lobar ICH has a higher risk of complications for PUD.

Conclusion

This study provides proof of the presence of a brain-gut axis. Among the complications of ICH, PUD and GERD were more common and associated with the site of hemorrhage.

Epidemiological characteristics of a population visiting a patient-centered informative website about irritable bowel syndrome

BACKGROUND AND AIMS

Irritable bowel syndrome (IBS) is a chronic disorder characterized by abdominal pain and an altered bowel habit. The aim of this study was to evaluate the characteristics of a population visiting a patient-centered informative website about IBS.

METHODS

Five digital surveys were used to assess the Rome IV criteria, red flag symptoms, healthcare use, psychological comorbidities, quality of life, symptom severity, diet, physical activity. Patients were divided into a Rome positive and negative population with the Rome positive population being further subtyped based on dominant stool pattern.

RESULTS

Red flag symptoms (42%) and comorbid psychological disorders (65% anxiety and 39% depression) were common. Despite consulting health care professionals and therapy, most patients (96%) still experienced moderate to severe symptoms with an average impact on quality of life. 73% performed regular physical exercise and 25% of the Rome positive population followed the FODMAP diet. Almost all participants consulted a health care professional at one point in time and used some form of therapy. 54% of the patients believed there is generally sufficient information available and 57% thinks that their physician takes IBS seriously. However, only 41% thinks that their physician has sufficient knowledge about IBS.

CONCLUSIONS

This study underlines the importance of a thorough characterization of IBS patients. Furthermore, patients expressed an urgent need for high quality information and education for both health care professionals and patients.

The Mediterranean Diet in Paediatric Gastrointestinal Disorders

The Mediterranean diet is considered one of the healthiest dietary patterns worldwide, thanks to a combination of foods rich mainly in antioxidants and anti-inflammatory nutrients. Many studies have demonstrated a strong relationship between the Mediterranean diet and some chronic gastrointestinal diseases. The aim of this narrative review was to analyse the role of the Mediterranean diet in several gastrointestinal diseases, so as to give a useful overview on its effectiveness in the prevention and management of these disorders.

Association between impaired healing after orthognathic surgery and irritable bowel syndrome: A case report and literature review

Introduction

In the disease irritable bowel syndrome (IBS), gastrointestinal function is worsened even though no organic abnormalities are observed in the gastrointestinal mucosa. We report the case of an orthognathic surgery patient with suspected irritable bowel syndrome.

Case

In September 2017, a 15-year-old Japanese female was referred to us with dental crowding, malocclusion, and mandibular protrusion. In June 2019, a disagreement with classmates led to abdominal pain, diarrhea, and hemorrhage; in August 2019, a preoperative blood test showed sudden anemia, and her surgery was thus postponed. Subsequent upper and lower gastrointestinal endoscopy revealed no organic abnormality, and no definitive diagnosis was made. In March 2020, after an improvement in anemia was observed, a segmental Le Fort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) were performed under general anesthesia. On the third post-operative day, due to the mucosal dehiscence adjacent to the suture part, the titanium plate was exposed, and irrigation of the wound with normal saline solution and oral hygiene instruction was continued daily for 2 weeks. Two years and eight months have passed since the surgery, and the healing of the oral mucosa and bone has been uneventful.

Discussion

The relationship between IBS and post-operative impaired healing associated with the fragility of the oral mucosa is unknown. However, psychological stress has been reported as a cause of IBS and to be related to oral microorganisms.

Conclusion

Reducing risk factors for IBS and maintaining proper perioperative oral hygiene is essential in managing similar cases.

•

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with recurrent abdominal pain.

•

It is difficult to diagnose IBS since the clinical symptoms are confusing.

•

IBS and psychological stress affect post-surgical healing.

•

Reducing risk factors for IBS and maintaining proper perioperative oral hygiene is essential in the management.

Two Gold Kiwifruit Daily for Effective Treatment of Constipation in Adults-A Randomized Clinical Trial

Chronic constipation is highly prevalent worldwide and may be managed with two green or three gold kiwifruit daily. It is unknown whether a smaller standard serve of gold kiwifruit (two daily) is as effective in constipation management. The study aimed to improve chronic constipation with two gold kiwifruit and psyllium in lieu of a placebo daily over four weeks. Adult participants (18-65 years) with functional constipation (FC, n = 11), constipation-predominant irritable bowel syndrome (IBS-C, n = 13), and healthy controls (n = 32) were block-randomized to the treatment order: gold kiwifruit (2/day) or psyllium (fiber-matched, 7.5 g/day) for four weeks, followed by four weeks washout before crossover. Outcomes included alterations of Gastrointestinal Symptom Rating Scale (GSRS) domains and weekly complete spontaneous bowel movements (CSBM) as part of a larger study. Both interventions reduced GSRS constipation domain scores in all subjects compared to baseline values (p = 0.004). All participants reported significantly more weekly CSBM (p = 0.014). Two gold kiwifruit decreased straining (p = 0.021). Two gold kiwifruit daily are as effective as fiber-matched psyllium in treating constipation in adults and should be considered as a treatment option.

Clinical study on sequential treatment of severe diarrhea irritable bowel syndrome with precision probiotic strains transplantation capsules, fecal microbiota transplantation capsules and live combined bacillus subtilis and enterococcus faecium capsules

Objective

To study the effect of precision probiotic strains transplantation capsules on diarrhea irritable bowel syndrome compared with fecal microbiota transplantation capsules and live combined bacillus subtilis and enterococcus faecium capsules.

Methods

Two patients with severe irritable bowel syndrome were treated with precision probiotic strains transplantation capsules, fecal microbiota transplantation capsules and live combined bacillus subtilis and enterococcus faecium capsules in sequence. IBS-SSS, IBS-QoL, GSRS, stool frequency, stool character, degree of abdominal pain, GAD-7, and PHQ9 scores of patients at 0, 2, 4, 6, 8, 10, and 12 weeks of treatment were monitored and recorded, and stool samples were collected for metagenomics and metabolomics.

Results

It was found that the IBS-SSS score of patient case 1 decreased by 175 points and that of patient case 2 decreased by 100 points after treatment of precision probiotic strains transplantation capsules. There was no significant decrease after fecal microbiota transplantation capsules and live combined bacillus subtilis and enterococcus faecium capsules were used. At the same time, compared with fecal microbiota transplantation and live combined bacillus subtilis and enterococcus faecium capsules, the IBS QoL, stool frequency, stool character, degree of abdominal pain and GAD-7 score of patient case 1 improved more significantly by the precision probiotic strains transplantation capsules. And the stool frequency and stool character score of patient case 2 decreased more significantly. Intestinal microbiota also improved more significantly after the precise capsule transplantation treatment. And we found Eubacterium_ Eligens showed the same change trend in the treatment of two patients, which may play a role in the treatment.

Conclusion

precision probiotic strains transplantation capsules is more beneficial to improve the intestinal microbiota of patients than microbiota transplantation capsule and live combined bacillus subtilis and enterococcus faecium capsules, so as to better alleviate clinical symptoms. This study provides a more perfect and convenient therapeutic drugs for the treatment of IBS.

Dietary Modification for the Restoration of Gut Microbiome and Management of Symptoms in Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder leading to chronic debilitating issues. A healthy diet plays an integral role in maintaining the gut microbiota equilibrium, thus promoting digestive health. The structure and function of gut microbiota are affected by genetics and environmental factors, such as altered dietary habits, gastroenteritis, stress, increased use of alcohol and drugs, and medication use. Whereas there are various management approaches cited in the literature to manage symptoms of IBS, the purpose of this article is to focus on dietary options that will restore the gut microbiome and help in managing IBS symptoms. Some of the diets that are discussed in this article include a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, gluten-free/wheat-free diet, high-fiber diet, dietary and herbal supplements (psyllium, peppermint oil), and probiotics/prebiotics/synbiotics. The clinical practice guidelines recommended by the American College of Gastroenterology outlines evidence-based dietary recommendations for patients with IBS to manage symptoms. Recent advancements in the dietary management of IBS highlighting the use of a patient-centered, personalized nutrition approach along with lifestyle changes, pharmacological therapies, and psychosocial and behavioral interventions are also reviewed and discussed.

Irritable bowel syndrome in adults: Prevalence and risk factors

Introduction

The prevalence of irritable bowel syndrome (IBS) ranges from 7 to 18% over the world. We aimed to assess the prevalence and risk factors of irritable bowel syndrome in adults.

Methodology

We conducted a cross-sectional study of IBS prevalence and risk factors from March to May 2022 at KRL Hospital Islamabad. 300 people were given Pre-validated Performa's. Our research adheres to the principles outlined in the Helsinki Declaration. The PSS was used to measures how much stress a person has felt in the past month.

The higher the score, the more stressed the person appears to be. A variety of mental health disorders can be evaluated using this method. Data on dietary and lifestyle factors associated with IBS for the last 12 months was also collected from the participants.

Results

The majority of patients, 70%, were classed as Grade 1 and 146 (48.66%) reported abdominal pain associated with defecation. 162 (54%) individuals reported high levels of tea consumed, 81 (27%) consumed coffee and 57 (19%) reported carbonated drinks consumed. 139 individuals reported having Vigorous-Intensity activity, out of which 69 (49.64%) spend 60 min of vigorous activity in a day.

Conclusion

Screening patients for IBS on a regular basis is critical, especially in the younger demographic. If a patient experiences any symptoms of IBS, they should contact their doctor immediately. Consider the care of patients with chronic gastrointestinal complaints, particularly in women and those at greater risk of developing the illness.

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Perceived Stress Scale (PSS) measures how much stress a person has felt in the past month.

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The Chalder Fatigue Scale (CFS) is used to measure fatigue.

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We recommend the younger population to be screened for IBS on a regular basis.

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Persistent gastrointestinal symptoms, especially women and those at high risk of the condition, it is critical to take this into account.

Systematic review and meta-analysis of Chinese herbal formula Tongxie Yaofang for diarrhea-predominant irritable bowel syndrome: Evidence for clinical practice and future trials

Introduction: Diarrhea-predominant irritable bowel syndrome (IBS-D) significantly decreases the quality of life of patients and their families, and affects patients' mental health. No specific western medications are available. Ancient classical Chinese medical texts have recognized Tongxie Yaofang (TXYF) as a therapy for diarrhea which is widely used in clinical practice. Standard TXYF prescription (S-TXYF) is composed of four herbal medicines: Atractylodes macrocephala Koidz. [Asteraceae; Rhizoma Atractylodis Macrocephalae.], Paeonia lactiflora Pall. [Ranunculaceae; Paeoniae Radix Alba], Citrus × aurantium L. [Rutaceae; Citri Reticulatae Pericarpium] and Saposhnikovia divaricata (Turcz. ex Ledeb.) Schischk. [Umbelliferae; Saposhnikoviae Radix]. This review aimed to evaluate the therapeutic effects and safety of S-TXYF for IBS-D. Methods: Eight English and Chinese electronic databases were searched from their inception to 25 December 2021 for randomized controlled trials (RCTs) comparing S-TXYF with placebo, western medications or no treatment for IBS-D. The primary outcome was the global improvement of IBS-D symptoms. Data were analyzed using Cochrane's Revman 5.4 software. Evidence certainty was assessed using the online GRADEpro tool for the primary outcome. Results: Eleven RCTs involving 985 adults with IBS-D were included. For global improvement of symptoms, S-TXYF was superior to western medication and placebo (moderate evidence by GRADE). Regarding the improvement of stool consistency, stool frequency and abdominal pain, S-TXYF was significantly effective than placebo. In addition, S-TXYF was superior to western medication on improving the quality of life and relieving anxiety. Six trials reported adverse events: five of them reported (non-serious) adverse events occurred in both groups, and one trial reported that 3 cases with adverse events (constipation, elevation in liver-enzyme, nausea) occurred in S-TXYF group and 3 cases with adverse events (abdominal distension, nausea) occurred in placebo group. Conclusion: Although current results showed that S-TXYF may have potential to treat IBS-D and its use appears to be safe, no a clear and confirmed conclusion can be drawn from our review as the overall inadequate design of the included trials reviewed. So more rigorous trials are warranted to establish confirmed evidence on its benefits and safety.

Association of Diet, Body Mass Index, and Lifestyle on the Gastrointestinal Health Risk in a Sample of Adults

Gastrointestinal functional disorders are characterized by abnormalities in motility with visceral hypersensitivity, representing a global public health problem. We aimed to determine whether eating habits, lifestyle characteristics, and body mass index (BMI) are associated with gastrointestinal health risk. The Gastrointestinal Health (GIH) test of the World Gastroenterology Organization (WGO) and the Roma IV criteria were applied. We obtained information on food consumption habits and aerobic exercise, among other variables. Not exercising regularly, drinking water and eating vegetables less than recommended, having high body weight, and taking symptomatic medication were variables that explained 73% of the probabilities of not having good GIH (R² = 0.734). According to Rome IV criteria, women had a 50% higher risk than men of having functional bowel disorder (RR 1.6, 95% CI: 1.04, 2.45). Among the men studied, eating few or no vegetables and drinking less than 1 L of water daily was more frequent; however, the women had significantly more intestinal symptoms. In addition, constipation was higher among women than men (p = 0.020). All of the above explains the prognostic value of eating habits and the importance of paying attention to body weight to reduce the risk of gastrointestinal disease.