Functional bowel disorders

Clinical perspectives on post-cholecystectomy syndrome: a narrative review

INTRODUCTION

Post-cholecystectomy syndrome (PCS) is a complex condition characterized by persistent or new symptoms following gallbladder removal, affecting up to 47% of patients. Despite being recognized since 1947, there is still no consensus on its etiology, diagnosis, and treatment.

AREAS COVERED

This narrative review explores the multifactorial etiology of PCS, including biliary and extra-biliary factors, and its varied clinical manifestations. A systematic literature search was conducted using keywords like 'etiology', 'clinical manifestations', 'diagnostic challenges', and 'management strategies'. The review covers traditional diagnostic methods, recent insights into pathophysiology, and current management approaches, such as dietary modifications, pharmacological treatments, and endoscopic interventions, with a focus on patient selection.

EXPERT OPINION

PCS presents significant clinical challenges due to its diverse presentations and lack of standardized diagnostic and therapeutic protocols. Effective management starts with careful patient selection before cholecystectomy to prevent unnecessary surgeries and reduce postoperative complications. Future research should aim to refine diagnostic criteria and develop predictive models for identifying at-risk patients. Personalized management strategies incorporating genetic, biological, and clinical factors are essential for improving outcomes. An integrated, patient-centered approach is crucial for addressing PCS complexities and enhancing the quality of life for affected patients.

The effects of waxy barley on defecation, sleep, mental health, and quality of life: a randomized double-blind parallel-group comparison study

BACKGROUND

Dietary fiber (DF) is beneficial for preventing constipation, and the metabolites produced by gut microbiota fermentation are suggested to positively influence on depression and sleep. Additionally, constipation has been reported to affect mental health and health-related quality of life (HRQoL). This study aimed to increase DF intake and examined its effects on daily DF and β-G consumption using two types of waxy barley (WB), rich in DF with varying β-glucan (β-G) content. Additionally, this study examined the effects of WB consumption on defecation, sleep, mental health, and HRQoL.

METHODS

A randomized double-blind parallel-group comparison study was conducted on 68 young Japanese women, using Kirarimochi (Group K) as common WB cultivar and Fukumi Fiber (Group F) as high-β-G WB cultivar. Participants consumed WB rice for 4 weeks, targeting 3 g/day of β-G (48 g/day of WB). We estimated the intake of WB and DF including β-G from the daily records. Defecation was evaluated through daily records and Rome IV criteria-based surveys. Sleep, mental health, and HRQoL were evaluated using PSQI-J, J-PHQ-9, and SF-36, respectively.

RESULTS

Both groups consumed about 40 g/day of WB. DF and β-G intakes from barley were 6.3 g/2.5 g in Group K and 10.7 g/4.3 g in Group F. Regarding defecation, both groups showed increases defecation days, defecation frequency and stool amount, with no differences between groups. Regarding sleep, Group F showed a decrease (improvement) in the PSQI global score, with improvements noted between groups. Regarding mental health, both groups showed decreases (improvements) in the PHQ-9 score, with Group F showing improvement between groups. Regarding HRQoL, summary scores showed improvements: physical health in Group K and mental health in Group F.

CONCLUSION

To increase β-G intake, high-β-G WB cultivars are effective; however, WB cultivars overall can potentially serve as excellent sources of DF. Effects on defecation may be expected not only from high-β-G WB but also from common WB with β-G intake below the target of 3 g/day. Although high β-G WB may have more beneficial for sleep and mental health, additional studies are required.

Efficacy of Linaclotide in Functional Dyspepsia and Constipation-Predominant Irritable Bowel Syndrome Overlap: A Randomized Trial

BACKGROUND AND AIM

Linaclotide is effective in relieving constipation-predominant irritable bowel syndrome symptoms. However, few studies focus on the efficacy of linaclotide for overlapping symptoms of functional dyspepsia among irritable bowel syndrome patients. This study aimed to assess the efficacy of linaclotide compared with lactulose in patients with functional dyspepsia and constipation-predominant irritable bowel syndrome overlap.

METHODS

Seventy-eight patient were randomized (2:1) to receive linaclotide 290 μg or lactulose 20 mL daily for 4 weeks. The primary endpoint was the overall treatment satisfaction for gastrointestinal symptom relief. The secondary endpoints included score changes in functional dyspepsia, constipation-predominant irritable bowel syndrome symptoms, and psychological status.

RESULTS

Seventy-one patients (47 with linaclotide and 24 with lactulose) completed the study. A higher proportion of patients receiving linaclotide reported partial or complete relief of gastrointestinal symptoms compared with patients receiving lactulose (87.2% vs. 54.2%, p = 0.002). Dyspeptic symptoms (postprandial fullness/early satiety and bloating) and bowel symptoms (stool frequency, consistency, straining, sensation of complete evacuation, and lower abdominal discomfort) showed greater improvement in linaclotide-treated patients than in lactulose group (p < 0.05).

CONCLUSIONS

Linaclotide shows better efficacy for functional dyspepsia and constipation-predominant irritable bowel syndrome overlap compared with lactulose.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05134584.

Utility of a 13C-Spirulina Stable Isotope Gastric Emptying Breath Test in Diabetes Mellitus

BACKGROUND

The carbon-13 spirulina gastric emptying breath test (GEBT) is approved to identify delayed, but not accelerated, gastric emptying (GE). We compared the utility of the GEBT to scintigraphy for diagnosing abnormal GE in patients with diabetes mellitus.

METHODS

Twenty-eight patients with diabetes ate a 230-kcal test meal labeled with technetium 99 m and 13C-spirulina, after which 10 scintigraphic images and breath samples (baseline, 15, 30, 45, 60, 90, 120, 150, 180, 210, and 240 min) were collected on 2 occasions 1 week apart. We assessed the accuracy of 13C-spirulina GEBT excretion rate (percent dose multiplied by 1000 [kPCD] min-1) values to predict scintigraphic half-life and distinguish between normal, delayed, and accelerated GE and the intraindividual reproducibility of the GEBT.

KEY RESULTS

Scintigraphy revealed normal, delayed, and accelerated GE, respectively, in 17 (30%), 29 (52%), and 10 (18%) test results. GE T½ values measured with scintigraphy and GEBT were highly concordant within individuals; the intraindividual reproducibility was 34% (scintigraphy) and 15% (GEBT). Compared to current criteria, the kPCD150 (150 min) and kPCD180 values provided equally sensitive (90%) and more specific (81% vs. 67%) approach for distinguishing between delayed versus normal/accelerated GE. A new metric (kPCD60-kPCD15 min) was 90% sensitive and 83% specific for distinguishing between accelerated versus normal/delayed GE. These findings were used to create nomograms and an algorithm for interpreting GEBT results.

CONCLUSIONS AND INFERENCES

Among patients with poorly controlled diabetes, the 13C-spirulina GEBT can accurately and precisely assess GE and effectively distinguish between normal, delayed, and accelerated GE.

The Vibrating Capsule: Safety and Tolerability in Patients With Chronic Idiopathic Constipation

BACKGROUND

Chronic idiopathic constipation (CIC) remains a significant problem globally with increasing estimates for disease burden. In a Phase 3 placebo-controlled trial, a novel treatment using the Vibrating Capsule was recently shown to be effective in treating patients with CIC. However, its safety and tolerability has not been described in detail.

METHODS

We analyzed safety data from six trials encompassing the development of the Vibrating Capsule, including, dose-ranging and pivotal studies. The incidence of adverse events, treatment discontinuation, tolerability and satisfaction were assessed.

KEY RESULTS

A total of 800 patients who took either an active Vibrating Capsule or a sham/placebo (non-vibrating) but similar capsule from 6 studies were included in this post hoc analysis. The most common adverse gastrointestinal events were bloating (2.9%), abdominal pain (2.9%), nausea (2.3%) and diarrhea (1.9%). A sensation of vibration was reported by 11.7% of patients. The adverse events rates were low, and investigators categorized most of them as unrelated to treatment. There were no serious adverse events such as retention of therapeutic capsules and no patient stopped therapy or withdrew due to adverse effects. The majority of patients (83%) found the system convenient, with an overall treatment satisfaction rate of 71%.

CONCLUSIONS AND INFERENCES

The Vibrating Capsule, a first in class treatment for CIC was found to be safe and well tolerated by patients in clinical trials. No patient discontinued treatment due to adverse events.

Laxative Effect of Crataegus azarolus Leaves Decoction Extract Against Loperamide-Induced Constipation and Oxidative Stress in Rats

Constipation represents a common gastrointestinal disorder that has various adverse effects on the gastrointestinal tract. As a result, various civilizations have developed phytomedicines in order to treat and relieve its symptoms. In the current study, we evaluated the effect of Crataegus azarolus L. leaves decoction extract (CALDE) against loperamide (LOP)-induced constipation in rats. For 3 days, treated rats were administered LOP (3 mg/kg, b.w., p.o.) and CALDE (50, 100, and 200 mg/kg, b.w., p.o.) or yohimbine (2 mg/kg, b.w., p.o.). The gastric emptying test or intestinal transit time was calculated. The oxidative status was studied and evaluated using biochemical colorimetric methods. Results showed that CALDE administration improves gastric emptying and accelerates gastrointestinal transit. Pretreatment with LOP altered the defecation parameters and generated an oxidative status in healthy rats. In contrast, CALDE coadministration protected against the deregulation of intestinal motor function and frequency of defecation and significantly re-established oxidative marker levels. CALDE treatment demonstrated significant protection against experimental oxidative stress and constipation induced by LOP. Therefore, it can be considered a pharmacological drug to treat these gastrointestinal troubles.

Both general and central obesity are associated with increased risk of irritable bowel syndrome: A large-scale prospective cohort study

BACKGROUND

Obesity has emerged as a major public health concern worldwide. However, the relationship between obesity and irritable bowel syndrome (IBS) remains unclear.

OBJECTIVES

We aimed to systematically examine the association of both general and central obesity measures with risk of incident IBS in a large population-based cohort.

METHODS

Participants free of IBS, celiac disease, inflammatory bowel disease, and any cancer at baseline were included. Obesity was assessed using various measures of general and central obesity [i.e., Body mass index (BMI in kg/m2), waist circumference, etc.]. The primary outcome was incident IBS. The Cox proportional hazard model was conducted to estimate the association.

RESULTS

Among 416,124 participants (mean age 56.2 y), 133,775 (32.1%), 178,283 (42.8%) and 102,139 (24.5%) were BMI-defined normal, overweight and obesity at baseline. During a median of 14.6-y follow-up, 8744 (2.1%) incident IBS were identified. After multiple adjustments, individuals with obesity had a 7% higher risk of developing IBS than those with normal BMI [hazard ratio (HR): 1.07; 95% confidence interval (CI): 1.01, 1.13]. As for central obesity, individuals with the highest quartiles of waist circumference (HR: 1.14; 95% CI: 1.06, 1.27) and visceral adipose tissue volume (HR: 1.35; 95% CI: 1.04, 1.75) had a 14% and 35% greater risk of IBS compared with the lowest quartiles. A similar positive association was observed in other general and central obesity measures, with an 8-35% higher risk of IBS occurrence in the highest quartile compared with the reference group. Further sensitivity analyses and subgroup analyses demonstrated similar results.

CONCLUSIONS

Both general and central obesity are associated with an increased risk of developing IBS, suggesting the importance of obesity management.

Association Between Ethnicity and Treatment Preferences in Patients with Irritable Bowel Syndrome

BACKGROUND AND AIMS

Irritable bowel syndrome (IBS) poses a significant healthcare challenge, characterized by chronic gastrointestinal and extraintestinal symptoms impacting individuals' well-being. Treatment preferences may vary among patients from different ethnic groups, such as Arab and Jewish Israelis, necessitating tailored approaches.

METHODS

A bilingual (Hebrew/Arabic) questionnaire assessing patients' preferences regarding treatment goals was developed. It was administered online in Israeli IBS Facebook groups, as well as in two hospital gastroenterology clinics.

RESULTS

The study included 267 IBS patients (91 Arabs and 176 Jews). Demographic analysis revealed a higher proportion of females in both groups, with a significantly greater percentage among Jews compared to Arabs (84% versus 64.8%, respectively, P<0.001). The median age was 32 years for both Arabs and Jews (interquartile ranges of 26-42 and 24-62, respectively). Arabs exhibited higher rates of mixed-type IBS and constipation, while Jews had a higher prevalence of predominant diarrhea IBS. Arabs reported more bloating, higher rates of IBS-related comorbidities, and more medication usage. When asked to rate the importance of treatment goals, both populations preferred improvement in abdominal pain, bloating, and regular defecation, while assigning lower importance to improving difficulty in mental and/or physical aspects of intercourse, as well as arthralgia and myalgia. Arab patients assigned lower importance scores to various symptoms compared to their Jewish counterparts.

CONCLUSION

This study highlights the impact of ethnicity on patients' treatment goals. Understanding patients' preferences will enable tailoring an individual approach to each IBS patient.

Acupoint massage: a comprehensive descriptive review of its forms, applications, and underlying mechanisms

Acupoint massage is a non-invasive traditional therapy that has demonstrated reliable clinical outcomes in pain management, mental health relief, sleep disorder regulation, gastrointestinal treatment, and as an adjunct therapy for cancer. Its convenience and cost-effectiveness further enhance its appeal. However, the existing English literature lacks a systematic review that encompasses the various forms of acupoint massage. The acupoint massage forms adaptability is particularly notable when considering the diverse conditions, it addresses, as well as its applicability across different age groups and gender differences. Providing a comprehensive understanding, it is crucial to outline common practices and explore specific applications in key areas. The comprehensive understanding can create opportunities for effective collaboration between preclinical and clinical studies. Defining and categorizing different forms of acupoint massage is essential, alongside investigating the neural circuits involved in touch sensation. Future efforts should enhance collaboration with modern biology, facilitating the transition from empirical to evidence-based practice. This review summarizes forms, applications, and mechanisms of mainstream acupoint massage and provides insights for future research and applications, promoting deeper integration into healthcare.

The gut microbiota promotes pain in fibromyalgia

Fibromyalgia is a prevalent syndrome characterized by widespread pain in the absence of evident tissue injury or pathology, making it one of the most mysterious chronic pain conditions. The composition of the gut microbiota in individuals with fibromyalgia differs from that of healthy controls, but its functional role in the syndrome is unknown. Here, we show that fecal microbiota transplantation from fibromyalgia patients, but not from healthy controls, into germ-free mice induces pain and numerous molecular phenotypes that parallel known changes in fibromyalgia patients, including immune activation and metabolomic profile alterations. Replacing the fibromyalgia microbiota with a healthy microbiota substantially alleviated pain in mice. An open-label trial in women with fibromyalgia (Registry MOH_2021-11-04_010374) showed that transplantation of a healthy microbiota is associated with reduced pain and improved quality of life. We conclude that altered gut microbiota has a role in fibromyalgia pain, highlighting it as a promising target for therapeutic interventions.

Food Hypersensitivity: Distinguishing Allergy from Intolerance, Main Characteristics, and Symptoms-A Narrative Review

Background/Objectives: Food hypersensitivity remains an understudied and overlooked subject globally. It is characterized by adverse reactions to dietary substances, potentially triggered by various mechanisms. Food allergy, a subset of food hypersensitivity, denotes an immune response to food proteins categorized into immunoglobulin IgE-mediated or non-IgE-mediated reactions. Conversely, food intolerance, another facet of food hypersensitivity, refers to non-immunological reactions, in which the human body cannot properly digest certain foods or components, leading to gastrointestinal discomfort and other non-immune-related symptoms. The main objective of this study was to determine and differentiate the differences, characteristics, and types of food hypersensitivity. Methods: This study involved a comprehensive review of key research from 1990 onward, including review articles, prospective studies, nested case-control studies, and meta-analyses. Results: Recognizing these differences is essential for healthcare professionals to ensure accurate diagnosis, effective management, and improved patient outcomes, while also aiding dietitians in providing optimal nutritional and dietary guidance. Conclusions: there are big differences between the main characteristics, such as symptoms, complications, and treatments between allergies, and food intolerances. Commonly reported trigger foods include cow milk, gluten, eggs, nuts, and seafood.

Analysis of the distribution characteristics of infecting microorganisms in the wound tissue of patients with perianal abscess combined with infection and the influencing factors of wound healing

OBJECTIVE

This study aimed to analyze the distribution characteristics of infecting microorganisms in the wound tissue of patients with perianal abscess and infection, as well as to identify factors affecting wound healing.

METHODS

Two hundred patients with perianal abscess combined with infection admitted to our hospital from January 2023 to May 2024 were selected, all of whom underwent one-time radical surgery, and were divided into 155 cases with good quality of healing and 45 cases with poor quality of healing according to the healing status of wounds in the 2 weeks after surgery, and the traumatized tissue specimenss were collected for the cultivation and identification of infecting microorganisms to analyze the characteristics of the distribution of infecting microorganisms. The clinical data of the patients were collected, and the factors affecting wound healing were investigated using unifactorial and multifactorial analysis.

RESULTS

In this study, 316 strains of infecting microorganisms were detected in two hundred patients, including 213 Gram-negative bacteria, 80 Gram-positive, and 23 fungal strains, of which the Gram-negative bacteria were dominated by Escherichia coli (E. coli)and Klebsiella pneumoniae(K. pneumoniae), and the Gram-positive bacteria were dominated by Staphylococcus aureus. The results of univariate analysis showed that body mass index, diabetes mellitus, concomitant infections, and stool traits were influential factors affecting the poor quality of wound healing (P < 0.05). The results of multifactorial logistic regression analysis showed that body mass index, diabetes mellitus, concurrent infections and stool traits were independent risk factors influencing the poor quality of wound healing (P < 0.05, P<0.05 indicates that the factor is statistically significant).

CONCLUSION

This study suggests that BMI, diabetes, concurrent infection and stool characteristics are independent risk factors for poor wound healing in patients with perianal abscess and infection. In clinical practice, it is recommended to implement personalized interventions targeting the above factors (such as optimizing nutritional support, strict blood glucose control, strengthening infection management, etc.) to improve patient prognosis. In the future, the universality of this conclusion needs to be further verified through multi center and large sample studies.

Clinical practice guidelines for the diagnosis of constipation-predominant irritable bowel syndrome and functional constipation in adults: a scoping review

BACKGROUND

Constipation-predominant irritable bowel syndrome (IBS-C) and functional constipation (FC) are prevalent disorders with overlapping and fluctuating symptoms, which pose challenges for accurate diagnosis. This study aimed to assess the consistency of diagnostic criteria for IBS-C and FC in adults across clinical practice guidelines (CPGs).

METHODS

We conducted a scoping review of relevant CPGs by searching electronic databases (MEDLINE and CNKI) and the webpages of Health and Care Excellence (NICE), World Health Organization (WHO), World Gastroenterology Organization (WGO), the American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), Chinese Society of Gastroenterology (CSGE) from Jan 2012 to July 2024. The included CPGs should contain the diagnostic criteria for IBS-C, FC, or both.

RESULTS

We identified 27 CPGs, 14 for IBS-C diagnostic criteria, 9 for FC, and 4 for both IBS-C and FC. The Rome IV criteria were the most commonly applied by the included CPGs (59.3%), followed by the Rome III criteria (22.2%), and pathophysiology classification criteria (7.4%). Abdominal pain was emphasized in IBS-C CPGs (71.4%) but not in any FC CPGs, while spontaneous bowel movement (SBM) frequency was commonly used for FC (88.9%) but not mentioned in any IBS-C CPGs. While 40.7% CPGs acknowledged the similarity between IBS-C and FC, one CPG addressed abdominal pain intensity as a diagnostic criterion, using the 0-9 Likert scale to define painful constipation as a score greater than 4. 71.4% IBS-C CPGs recommended a positive symptom-based diagnosis, versus 11.1% of FC CPGs. Geographical differences were observed, Asian-based CPGs (14.3% of IBS-C CPGs and 11.1% of FC/IBS-C CPGs) recommended stool form type 3 on the Bristol Stool Form Scale (BSFS) and abdominal bloating as diagnostic features. 81.5% CPGs recommended colonoscopy based on alarm symptoms or age.

CONCLUSION

Inconsistent and regional variations of existing diagnostic criteria for IBS-C/FC were identified. Future improvements should focus on comprehensive characterizations of pain and constipation in both IBS-C and FC. Long-term advancements in understanding the underlying mechanisms, including gut microbiota and related metabolites, are essential for identifying objective biomarkers to improve differential diagnosis and reduce reliance on symptom-based criteria.

Elevated Fecal Biomarkers of Colo-Rectal Epithelial Cell Activity in Irritable Bowel Syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is a common functional gastro-intestinal disorder characterized by discomfort with constipation and/or diarrhea with unclear pathophysiology. We aimed to determine the activities of colorectal eosinophils, neutrophils and epithelial cells by biomarkers in feces reflecting these activities.

METHODS

Fecal samples were collected from 185 patients with IBS before and after 8 weeks of placebo or mesalazine treatment and from 40 healthy subjects. Calprotectin, eosinophil derived neurotoxin (EDN), eosinophil cationic protein (ECP), human neutrophil lipocalin (HNL) (pab/765) or dimer, human phospholipase BII-precursor (HPLBII-P) and myeloperoxidase (MPO) were measured by ELISA. Symptom scores were evaluated by diaries.

RESULTS

HPLBII-P, HNL (pab/765) and EDN, proteins secreted by intestinal epithelial cells, were elevated in IBS patients as compared to healthy subjects (p < 0.0001-p = 0.008). In contrast, the neutrophil proteins calprotectin, MPO and HNL dimer were unaltered. The eosinophilic protein ECP was lower in IBS (p = 0.001). HNL (pab/765) (p = 0.01) and EDN (p = 0.004) increased in IBS patients after mesalazine treatment. Colo-rectal mucosa showed strong staining of HPLBII-P and western blotting of fecal extracts showed the presence of mainly monomeric, epithelial-associated HNL.

CONCLUSIONS

The absence of signs of involvement of neutrophils and eosinophils in IBS suggests that activity of local epithelial cells rather than inflammation may be a major determinant of the disease. The measurements of EDN, HNL (pab/765), and HPLBII-P may serve as potential fecal biomarkers in the study and monitoring of IBS.

Impact of Positive Glucose, Lactose, and Fructose Hydrogen Breath Tests on Symptoms and Quality of Life in Irritable Bowel Syndrome

BACKGROUND

Gas production due to fermentation from fructose malabsorption (FM) or lactose malabsorption (LM) and small intestinal bacterial overgrowth (SIBO) contribute to the development of gastrointestinal symptoms in patients with irritable bowel syndrome (IBS). However, the impact of the carbohydrate malabsorption, unlike SIBO, is relatively unknown.

METHODOLOGY

A multicenter, prospective study of consecutive adults with IBS who underwent a hydrogen breath test (HBT) (glucose, 75 g; lactose, 25 g; or fructose, 25 g) was conducted. The proportion of patients who tested positive for glucose, fructose and lactose HBT were evaluated. The symptom severity, psychology, and quality of life of subjects with SIBO were compared with those having LM and/or FM. Independent factors associated with severe IBS (IBS-symptom severity scale: IBS-SSS > 300) were explored.

RESULTS

A total of 116 subjects were included (median age 56 years, male 35.3%). Of these, 23.3% (27/116), 85.7% (24/28), and 44.4% (16/36) of them tested positive for glucose, lactose, and fructose HBT, respectively. Among those with a positive HBT (n = 65), patients with SIBO were more likely to have the diarrhea-predominant subtype of IBS (77.8% vs. 47.4%, p = 0.014). Severe IBS was associated with SIBO, compared with LM/FM (SIBO: 36.4% vs. LM: 9.1%/FM 13.3%, p = 0.016). With multivariate analysis, SIBO (OR 5.25, p = 0.028) and depression (OR 5.59, p = 0.030) were independently associated with severe IBS.

CONCLUSION

Although LM and FM commonly co-exist in IBS, their clinical relevance appears to be less significant than that of SIBO. The connection between SIBO with depression reinforces the importance of the microbiome-gut-brain axis in IBS.

Vitamin D in Irritable Bowel Syndrome: Exploring Its Role in Symptom Relief and Pathophysiology

Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder. Despite its common occurrence, the pathophysiology of IBS remains not fully understood. Emerging evidence suggests that IBS is a multifactorial condition characterized by low-grade inflammation, immune system activation, impaired gut permeability, intestinal hypersensitivity, and alterations in intestinal microbiota. Recent data have highlighted the potential role of vitamin D in modulating these underlying mechanisms. Vitamin D is known to influence various cellular processes, including the regulation of the gut microbiome, immune response modulation, and anti-inflammatory effects, which may alleviate the altered gut function observed in IBS. Research indicates that individuals with IBS often have lower levels of vitamin D compared to healthy controls, suggesting a possible link between vitamin D deficiency and IBS. Vitamin D supplementation has been associated with improvements in IBS symptoms, such as bloating, flatulence, abdominal pain, constipation, and overall quality of life. The mechanisms by which vitamin D exerts these effects may involve direct or indirect modulation of immune responses, the production of antimicrobial peptides, and the regulation of gene expression related to serotonergic metabolism. Despite these promising findings, the exact pathways through which vitamin D affects IBS pathophysiology remain unclear. The aim of this review is to outline the current knowledge and evidence regarding these mechanisms, as well as the therapeutic potential of vitamin D supplementation in IBS patients. Exploring the connection between vitamin D and IBS may pave the way for innovative interventions, enhancing both management strategies and the quality of life for those affected by the disorder.

Effects of Lactococcus cremoris PS133 in 5-Hydroxytryptophan-Induced Irritable Bowel Syndrome Model Rats

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder marked by abdominal pain and irregular bowel habits. Recently, more and more evidence supports gut microbiota imbalance in IBS and highlights the potential of probiotics in restoring gut health and reducing symptoms. In this study, we explored the effects of Lactococcus cremoris PS133 (PS133) on an IBS-like condition in rats triggered by 5-hydroxytryptophan (5-HTP), a serotonin precursor. Eight-week-old Sprague Dawley rats received either PS133 or saline for 14 days, followed by 5-HTP to induce IBS-like symptoms. Colorectal distension tests showed that PS133 reduced visceral hypersensitivity. PS133 also protected intestinal mucin against 5-HTP-induced degradation, as seen in alcian blue staining, and increased the levels of tight junction proteins (occludin and zonula occludens-1) in the colon, indicating improved gut barrier integrity. Additionally, PS133 normalized the levels of substance P (a neuropeptide) in the spinal cord and altered 5-hydroxyindoleacetic acid (a serotonin metabolite) in the brain. Gut microbiota analysis revealed PS133 regulated specific bacterial groups, including [Eubacterium]_coprostanoligenes_group and Lactococcus. Overall, PS133 improved gut function, reduced IBS-like symptoms, and modulated gut microbiota, neurotransmitters, and intestinal barrier health in this IBS model.

Quality of life, functional impairment and healthcare experiences of patients with irritable bowel syndrome in Norway: an online survey

BACKGROUND

The present study is an online survey to determine the quality of life and functional impairment caused by irritable bowel syndrome (IBS) and the healthcare experiences of IBS patients in Norway, which has not been done previously.

METHODS

An author-developed, online questionnaire using Microsoft Forms program was applied. The questionnaire comprised 52 questions. The questionnaire was posted from 1 March to 17 April (a 48-day period) on the Norwegian Gastrointestinal Association website and in its magazine and social media posts.

RESULTS

The questionnaire was completed by 2727 patients. Of these patients 327 were excluded because they have not been diagnosed by a medical doctor. IBS reduced the quality of life in 97% of affected patients, including the social life in 90% and the sexual life in 69%. The unemployment rate of IBS patients in Norway 38%, which is 10-fold higher than that of the general population, and 94% of IBS patients reported that IBS impaired their work/study performance. About half of the patients had to discuss their abdominal symptoms with their general practitioner (GP) more than 10 times and wait more than 1 years before being diagnosed. Only 34% and 48% were satisfied with the help they received from their GP and gastroenterologist, respectively. Only 18% and 43% of the IBS patients felt that their GP and gastroenterologist, respectively, were sufficiently knowledgeable about IBS. Only 21% of the IBS patients was satisfied with the treatment they received.

CONCLUSIONS

IBS markedly reduces the affected patient's quality of life and their working productivity. IBS patients are generally dissatisfied with the clinical management they receive from GPs and gastroenterologists.

Genetic overlap between schizophrenia and constipation: insights from a genome-wide association study in a European population

BACKGROUND

Patients with schizophrenia (SCZ) experience constipation at significantly higher rates compared with the general population. This relationship suggests a potential genetic overlap between these two conditions.

METHODS

We analyzed genome-wide association study (GWAS) data for both SCZ and constipation using a five-part approach. The first and second parts assessed the overall and local genetic correlations using methods such as linkage disequilibrium score regression (LDSC) and heritability estimation from summary statistics (HESS). The third part investigated the causal association between the two traits using Mendelian randomization (MR). The fourth part employed conditional/conjunctional false discovery rate (cond/conjFDR) to analyze the genetic overlap with different traits based on the statistical theory. Finally, an LDSC-specifically expressed gene (LDSC-SEG) analysis was conducted to explore the tissue-level associations.

RESULTS

Our analyses revealed both overall and specific genetic correlations between SCZ and constipation at the genomic level. The MR analysis suggests a positive causal relationship between SCZ and constipation. The ConjFDR analysis confirms the genetic overlap between the two conditions and identifies two genetic risk loci (rs7583622 and rs842766) and seven mapped genes (GPR75-ASB3, ASB3, CHAC2, ERLEC1, GPR75, PSME4, and ACYP2). Further investigation into the functions of these genes could provide valuable insights. Interestingly, disease-related tissue analysis revealed associations between SCZ and constipation in eight brain regions (substantia nigra, anterior cingulate cortex, hypothalamus, cortex, hippocampus, cortex, amygdala, and spinal cord).

CONCLUSION

This study provides the first genetic evidence for the comorbidity of SCZ and constipation, enhancing our understanding of the pathophysiology of both conditions.

Assessing the impact of 25-hydroxyvitamin concentrations on mortality in chronic diarrhea: a cross-sectional analysis

Background

The aim of this study was to assess the relationship between serum 25-hydroxyvitamin levels and all-cause mortality in patients with chronic diarrhea.

Methods

We carried out a cross-sectional study using information drawn from the National Health and Nutrition Examination Survey (NHANES). To assess mortality outcomes, we compared our data with records from the National Death Index as of December 31, 2011. The NHANES data were used to determine mortality outcome. We used a Cox regression model-based approach to analyze the relationship between serum 25-hydroxyvitamin concentrations and mortality in chronic diarrhea patients.

Results

A total of 2,972 participants with chronic diarrhea were included in our study, 488 cases of all-cause mortality were recorded. The study showed an L-shaped relationship between 25-hydroxyvitamin concentrations and all-cause mortality with a threshold of 73.40 nmol/L. On the left side of the threshold, each 1-unit increase in 25-hydroxyvitamin concentrations was associated with a 2.2% reduction in the risk of all-cause mortality (HR 0.978; 95% CI: 0.969, 0.987); however, on the right side of the threshold, there was no significant correlation between 25(OH)D concentrations and all-cause mortality.

Conclusion

Serum 25-hydroxyvitamin D levels showed an L-shaped association with all-cause mortality in patients with chronic diarrhea, with 73.40 nmol/L as the potential threshold. However, because this was a cross-sectional study, only an association, not a causal relationship, can be inferred. Further prospective studies are needed to confirm these findings and explore the potential impact of vitamin D supplementation on mortality outcomes.

Spastic pelvic floor syndrome and puborectalis syndrome: the different stages of the same disease

PURPOSE

The diagnosis and treatment of puborectalis syndrome (PRS) and spastic pelvic floor syndrome (SPFS) are still up for debate. This study aims to investigate and examine the similarities and differences between PRS and SPFS.

METHODS

This study recruited 13 PRS cases, 10 SPFS cases, and 16 controls. Pelvic magnetic resonance imaging (MRI), histology, and ultrastructural pathology were explored. Additionally, anorectal manometry was performed prior to surgery, and Wexner constipation scores and patient assessment of constipation quality of life (PAC-QOL) scores monitored before surgery and 6 and 12 months post-surgery.

RESULTS

The puborectalis thickness in the pelvic MRIs of the SPFS and control groups did not appear to differ (4.62 ± 0.38 vs 4.56 ± 0.47, p = 0.378); however, the puborectalis in the PRS group was substantially thicker than that of the SPFS (8.65 ± 1.17 vs 4.62 ± 0.38, p < 0.001). The SPFS group showing atrophy and degeneration of muscle fibers and the PRS group exhibiting necrosis of muscle fibers, both groups had distorted texture myofibrils, disorganized arrangement, and rough Z lines; however, in severe cases of PRS group, localized myofibrils fracture and myofilament dissolution presenting as vacuolation. Patients with normal preoperative rectal propulsion force had improvements in postoperative Wexner constipation scores and PAC-QOL scores.

CONCLUSION

Histological and ultrastructural pathological evidence suggests that SPFS and PRS are distinct phases of paradoxical puborectalis syndrome (PPS). Furthermore, one indication for PPS surgical treatment is normal rectal evacuation pressure.

Long-term outcome of laparoscopic ventral rectopexy for full-thickness rectal prolapse: the PEXITY study

BACKGROUND

Laparoscopic ventral mesh rectopexy (LVR) has gained increasing acceptance for the treatment of patients with a full-thickness rectal prolapse (RP), but literature on follow-up of at least 10 years is scarce. We studied recurrence rate, long-term functional results and quality of life in patients who had LVR for RP more than 12 years ago.

METHOD

The study population consisted of patients who could be contacted among the 175 who had undergone LVR for RP and whose short- and medium-term outcomes were published in 2012. We studied the long-term recurrence rate (Kaplan-Meier), functional outcome (Wexner and ODS scores), quality of life (EuroQol) and satisfaction of the patient through clinical examination(s), specific scores and questionnaires.

RESULTS

Of the 175 patients, 14 patients had exclusion criteria, 57 had died, and 42 were lost to follow-up, leaving 62 patients for analysis. Seventeen patients presented with a recurrence (10.5%) at the 10-year follow-up. The only statistically significant risk factor for recurrence was recurrent RP (HR = 11.5 (2.54-52.2), P = 0.002). The median faecal incontinence score was 4 (0-10) and significantly worse in patients who had a recurrence [12 (7-13) vs 3 (0-9); P = 0.016]. The median obstructive defaecation score was 6 (3-12). The median quality of life score was 7 (6-8). Most patients who presented with a recurrence said they would undergo the operation again and recommended it, as would patients with no recurrence.

CONCLUSION

LVR for RP is a safe and efficient technique with sustainable long-term results that shows long-term efficacy at > 10 years after the operation.

Genome-Wide DNA Methylation Identifies Potential Disease-Specific Biomarkers and Pathophysiologic Mechanisms in Irritable Bowel Syndrome, Inflammatory Bowel Disease, and Celiac Disease

BACKGROUND AND AIMS

Irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease (CeD) present with similar gastrointestinal (GI) symptoms. DNA methylation-based biomarkers have not been investigated as diagnostic biomarkers to classify these disorders. We aimed to study DNA methylation profiles of IBS, IBD, CeD, and healthy controls (HC), develop machine learning-based classifiers, and identify associated gene ontology (GO) terms.

METHODS

Genome-wide DNA methylation of peripheral blood mononuclear cells from 315 patients with IBS, IBD, CeD, and HC was measured using Illumina's 450K or EPIC arrays. A methylation dataset on 304 IBD and HC samples was used for external validation. Differential methylation was measured using general linear models. Classifiers were developed using penalized generalized linear models using double cross-validation controlling for confounders. Functional enrichment was assessed using GO.

RESULTS

Three hundred and fifteen participants (148 IBS, 47 IBD, 34 CeD, and 86 HC) had DNA methylation data. IBS-IBD and IBD-CeD showed the highest number of differentially methylated CpG sites followed by IBD-HC, CeD-HC, and IBS-HC. IBS-associated genes were enriched in cell adhesion and neuronal pathways, while IBD- and CeD-associated markers were enriched in inflammation and MHC class II pathways, respectively (p < 0.05). Classification performances assessed using area under the receiver operating characteristic curves (AUC) for IBS-IBD, IBS-CeD, and IBD-CeD were 0.80 (95% CI = 0.7-0.87, p = 6.75E-10), 0.78 (95% CI = 0.68-0.86, p = 4.57E-10), and 0.73 (95% CI = 0.62-0.83, p = 0.03), respectively. The performance of IBD-HC was successfully validated using external data (AUC = 0.74 [95% CI = 68-0.80, p < 0.001]).

CONCLUSIONS

Blood-based DNA methylation biomarkers can potentially distinguish chronic GI disorders that present with similar symptoms. GO suggested functional significance of the classifiers in disease-specific pathology.

Associations between constipation risk and lifestyle, medication use, and affective symptoms in patients with schizophrenia: a multicenter cross-sectional study

PURPOSE

To investigate the association between lifestyle and atypical antipsychotic drug use in patients with schizophrenia and the risk of constipation and to assess the impact of anxiety and depressive symptoms on constipation risk.

METHODS

Cross-sectional convenience sampling was employed, and 271 participants aged 20-65 were enrolled. Data were collected via a structured questionnaire comprising participants' demographic data, medication information, dietary behavior assessment, and the Baecke Physical Activity Questionnaire, Beck Depression Inventory-II, and Beck Anxiety Inventory. IBM SPSS 24.0 with multivariate logistic regression was used for data analysis. We performed a subgroup analysis of anticholinergic drugs via multivariate logistic regression.

RESULTS

In total, 180 participants had functional constipation; risk factors included female sex, anxiety symptoms, depressive symptoms, and quetiapine and aripiprazole use. Patients who drank more than 3,000 cc of water daily or used risperidone were less likely to have functional constipation. Depressive and anxiety symptoms were risk factors even after adjusting for sex, use of anticholinergics and laxatives, consuming two servings of fruit, consuming three servings of vegetables, consuming more than 3,000 cc of water daily, physical activity, medical comorbidity, chlorpromazine equivalent dose, and atypical antipsychotic use. Similar associations were found for two affective symptoms and functional constipation in the subgroup analysis of anticholinergic drugs.

CONCLUSION

The prevalence of functional constipation in patients with schizophrenia was 66.4%. The risk factors included female sex, anticholinergics, aripiprazole, quetiapine, and depressive and anxiety symptoms. Risperidone users and those who drank 3000 cc of water daily were less likely to have constipation.

The Effectiveness of Caffeine in Reducing Constipation in Adults: A Systematic Review

INTRODUCTION AND HYPOTHESIS

Constipation is defined as infrequent stools/difficultly passing stools, or the sensation of incomplete emptying. The prevalence of constipation is estimated at 14% worldwide. Caffeine is believed to increase gastric motility in the colon, causing a laxative effect. The results of the studies in the literature are conflicting. The aim of this review is to assess the effectiveness of caffeine in reducing constipation in adults.

METHODS

We searched the Cochrane Library, AMED, MEDLINE, EMBASE, Web of Science and CINAHL. Search terms included "constipation", "faecal impaction" and "caffeine" in different forms. The screening of the titles was carried out by two independent reviewers for trials that assessed the effect of caffeine on constipation. We assessed the quality of the studies included and the data collated. ROBINS-I and risk-of-bias tools were employed to assess for risk of bias in the studies included.

RESULTS

Eight studies were included in the final review. The studies assessed caffeine in the forms of coffee, tea, energy drinks, cocoa and kombucha with different doses. Three studies were at a low risk of bias, 3 were at a moderate risk of bias and the randomised controlled trial (RCT) had some concerns regarding blinding. Four studies concluded that caffeine may be effective in reducing constipation and 4 studies showed no improvement or an increase in constipation. Meta-analysis was not done as the studies were too dissimilar in interventions and outcome assessments.

CONCLUSION

The results of the studies are conflicting. Further rigorously designed and conducted RCTs need to be carried out to substantiate the effectiveness of caffeine on reducing constipation in adults.

Low-FODMAP Diet for Irritable Bowel Syndrome: Insights from Microbiome

Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder characterized by chronic abdominal pain, bloating, and altered bowel habits. Low-FODMAP diets, which involve restricting fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, have emerged as an effective dietary intervention for alleviating IBS symptoms. This review paper aims to synthesize current insights into the impact of a low-FODMAP diet on the gut microbiome and its mechanisms of action in managing IBS. We explore the alterations in microbial composition and function associated with a low-FODMAP diet and discuss the implications of these changes for gut health and symptom relief. Additionally, we examine the balance between symptom improvement and potential negative effects on microbial diversity and long-term gut health. Emerging evidence suggests that while a low-FODMAP diet can significantly reduce IBS symptoms, it may also lead to reductions in beneficial microbial populations. Strategies to mitigate these effects, such as the reintroduction phase and the use of probiotics, are evaluated. This review highlights the importance of a personalized approach to dietary management in IBS, considering individual variations in microbiome responses. Understanding the intricate relationship between diet, the gut microbiome, and IBS symptomatology will guide the development of more effective, sustainable dietary strategies for IBS patients.

Blastocystis ST1: Protein Profile and Specific Serum Immunoglobulin in Irritable Bowel Syndrome (IBS) Patients

PURPOSE

Blastocystis sp. is a common enteric human parasite, which recently has been linked to gastrointestinal disorders i.e. Irritable Bowel Syndrome (IBS) and symptomatic patients (non IBS). Analyzing antibodies level in these patients could help in differential diagnosis. The current study aimed to identify the protein profile of the Blastocystis ST1 (Syrian strain: OR537347) lysates and to investigate the differences in IgG serum immunoglobulin between patients with IBS and non IBS.

METHODS

Twenty two IBS (Rome III) and nineteen patients suffering from different gastrointestinal disorders (non IBS), positive for Blastocystis were enrolled in this study. SDS-PAGE was used to identify the protein profile of the Blastocystis ST1 lysates and immunoblotting using sera from patients was used for reactivity compared to known Blastocystis protein targets.

RESULTS

The crude protein profile of Blastocystis ST1 showed 24 protein bands ranged between 10 and 130 kDa. Western blot demonstrated that the proteins (27-29);32;(39-42);(50-51) kDa had similar immunogenicity characteristic in IBS and non IBS patients while the proteins (60-95 kDa) only interacted with IBS patients' sera.

CONCLUSIONS

Our results highlighted the importance of Blastocystis proteins 60-95 kDa (probably a metalloproteases) in IBS patients compared to non IBS, suggesting that these metalloproteases may be important Blastocystis antigens and can be used as a serologic test tool or as a biomarker for differential diagnosis.

Efficacy of Tui Na in idiopathic constipation in children with cerebral palsy: a randomized controlled clinical trial

Objective

To investigate the efficacy and potential adverse events of Tuina therapy for idiopathic constipation in children with cerebral palsy (CP).

Methods

A total of 60 CP children with idiopathic constipation were enrolled and randomly divided into Tuina and control groups. The control group was treated with basic treatment and 12 sessions of lactulose oral solution, whereas the Tuina group received basic treatment and 12 sessions of infantile Tuina treatment. The following parameters were compared: the Bristol stool form scale (BSFS), the Constipation Assessment Scale (CAS) and the improvement in constipation. In addition, adverse effects were recorded.

Results

At 4 weeks after the final treatment, the percentage of infants whose constipation improved was 23 (76.7%) in the Tuina group and 21 (70.0%) in the control group (P = 0.771). Initially, the CAS score, weekly bowel movements and proportion of infants with bowel evacuation ≥2 h were comparable between the two groups (P > 0.05). At 4 weeks after the final treatment, the CAS score, weekly bowel movements and proportion of infants with bowel evacuation ≥2 h all significantly improved (P < 0.05) compared with those in the initial situation. However, no difference was found in either group at 4 weeks after the final treatment. No serious adverse reactions (such as diarrhea, abdominal pain, vomiting, subcutaneous redness, skin breakage, or syncope) were recorded.

Conclusions

Tuina was as effective as medical care in addition to basic treatment for both groups. The results of this study suggest that Tuina, as a nonpharmacological therapy, may be helpful as an alternative treatment for constipation. More advanced research and large-sample studies should be conducted.

High leafy and root vegetables and high rice dietary patterns were associated with primary and secondary bile acid levels in the feces

Colorectal cancer has the second highest mortality among cancer sites worldwide, with increasing morbidity, high recurrence rates, and even poorer postoperative quality of life. Therefore, preventive strategies for colorectal cancer should be established. This study aimed to cross-sectionally explore dietary patterns affecting the intestinal metabolism of bile acids (BAs), a risk factor for colorectal cancer, in young Japanese women. We collected fecal samples for intestinal microbiota and BA analysis. We used the Bristol scale to determine 1-week defecation status. Moreover, the brief-type self-administered diet history questionnaire was used for habitual dietary intake status. Reduced-rank regression analysis revealed dietary patterns related to fecal BA levels. The relationship between dietary patterns and fecal BA levels was adjusted for defecation status and intestinal microbiota variables using analysis of covariance. Reduced-rank regression analysis generated two dietary pattern scores related to fecal BA levels. First, the score was associated with a greater intake of leafy and root vegetables, and higher values were associated with greater fecal cholic and chenodeoxycholic acid levels and lower deoxycholic and lithocholic acid levels. Second, the score was associated with greater rice intake and lower Western sweets, pork, beef, and egg intake, and higher values were associated with lower deoxycholic and lithocholic acid levels. These relationships remained after adjusting for intestinal microbiota and defecation status variables.

Gut Neuropathies and Intestinal Motility Disorders

BACKGROUND

The enteric nervous system plays a key role in the coordination of gastrointestinal motility together with sympathetic, parasympathetic, and extrinsic sensory pathways. In some cases, abnormalities in neural activity in these pathways contribute to disorders of gut motility. Where this is associated with damage or death of enteric neurons, usually detected by microscopy, this is considered a gut neuropathy.

PURPOSE

This review summarizes recent advances in the identification of neuropathies in a range of gastrointestinal motility disorders.

Efficacy and Safety of Noninvasive Electrical Neuromodulation for Treatment of Functional Constipation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Functional constipation (FC) is a prevalent disorder with large disease burden and high associated cost. Noninvasive electrical neuromodulation (NEN) has been studied for treatment of FC, but its overall efficacy and safety remain unclear. This meta-analysis evaluates the efficacy and safety of NEN for treatment of FC.

MATERIALS AND METHODS

A search of PubMed, Cochrane Library, Embase, and Web of Science data bases was completed for randomized controlled studies assessing the efficacy and safety of NEN in patients with FC through June 2024. We performed a meta-analysis using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, with 95% CIs.

RESULTS

The analysis included eight randomized controlled trials with 1465 participants. Compared with sham interventions, NEN significantly increased the proportion of patients having ≥three spontaneous bowel movements per week (RR [95% CI] = 2.47 [1.79, 3.40], p < 0.00001), decreased the number of patients using laxative for FC (RR [95% CI] = 0.81 [0.69, 0.95], p = 0.01), decreased the overall constipation severity (MD [95% CI] = -0.58 [-0.81, -0.35], p < 0.00001), and improved the constipation-specific quality of life (MD [95% CI] = -0.24 [-0.32, -0.16], p < 0.00001). There was no significant difference in the frequency of adverse events between NEN and sham interventions (RR [95% CI] = 1.30 [0.77, 2.19], p = 0.32), and participant drop-out rate with NEN was lower (RR [95% CI] = 0.38 [0.17, 0.84], p = 0.02). Mechanistically, NEN was found to modulate the autonomic function (p < 0.00001) and improve the rectal sensation (p = 0.03).

CONCLUSIONS

NEN relieves constipation symptoms, improves quality of life, and reduces use of pharmacologic remedies in adults with FC. These effects seem to be modulated through improved autonomic function and rectal sensation. NEN is safe, well-tolerated, and has a high level of patient compliance.

The Effect of Dietary Fiber on Hyperkalemia in Maintenance Hemodialysis Patients: A Cross-Sectional Study

OBJECTIVE

To explore the relationship between dietary fiber (DF) intake and hyperkalemia in maintenance hemodialysis (MHD) patients.

METHODS

A total of 110 MHD patients were included, including 67 males and 43 females. Patients were divided into normal serum potassium group (N) and a hyperkalemia group (H) according to the serum potassium level before dialysis. The daily diet was recorded by the 3-day dietary recording method. The daily dietary nutrient intake of patients was analyzed. Logistic regression was used to analyze the relationship between hyperkalemia and DF intake. A receiver operating characteristic curve was used to analyze the cutoff value of DF intake to prevent hyperkalemia.

RESULTS

Of the 110 patients, 38 had hyperkalemia (serum potassium >5.5 mmol/L) before dialysis. There was no difference in sex, residual kidney function, body mass index, energy intake, fat intake, protein intake, calcium intake, sodium intake, phosphorus intake or the administration history of potassium-lowering drugs between the 2 groups (P > .05). Compared with the H group, patients in the N group had higher carbohydrate intake (315 ± 76 g/d vs. 279 ± 66 g/d, P = .016), dietary fiber intake (19 ± 5 g/d vs. 12 ± 8 g/d, P < .0001), and potassium intake (1,698 ± 392 mg/d vs. 1,533 ± 413 mg/d, P = .041), and more patients in group N used renin-angiotensin-aldosterone system inhibitors (52.78% vs. 23.68%, P = .003). However, the number of patients with constipation in group N was less than that in group H (20.83% vs. 42.11%, P = .018). Logistic regression analysis showed that DF intake was an independent protective factor for hyperkalemia [P < .0001, odds ratio = 0.766 (95% confidence intervals: 0.675-0.870)]. Receiver operating characteristic analysis showed that daily intake of DF greater than 15.33 g may be helpful to prevent hyperkalemia.

CONCLUSION

Insufficient dietary nutrient intake is prevalent in MHD patients, especially DF intake, which may be associated with hyperkalemia. Clinically, attention should be given to the dietary balance of MHD patients, especially DF intake.

Biofeedback efficacy for outlet dysfunction constipation: Clinical outcomes and predictors of response by a limited approach

BACKGROUND

Functional defecation disorders (FDD) are a common etiology of refractory chronic constipation (CC). FDD diagnosis (dyssynergic defecation [DD] and inadequate defecatory propulsion [IDP]), requires diagnostic tests including anorectal manometry (ARM) and balloon expulsion test (BET). Biofeedback (BF) is the treatment of choice for DD. The aims of our study were to evaluate: the outcome of BF in a group of constipated patients with defecatory disorders of any etiology; the efficacy of two simple diagnostic tools in predicting BF outcome in the short-term.

METHODS

One hundred and thirty-one refractory CC patients failing the BET underwent BF therapy. Before BF, all patients underwent the following: ARM. Straining questionnaire. The answers were: "belly muscles"; "anal muscles"; "both"; "Don't know/No answer." Digital rectal examination augmented by abdominal palpation on straining (augmented-DRE). The BF therapist was blinded to ARM, straining questionnaire, and augmented-DRE results.

KEY RESULTS

Eighty-one patients responded to BF. Gender, age, and IBS-C showed no significant impact on BF response. Both DD and IDP responded equally to BF, while the rate of response in patients with isolated structural pelvic floor abnormalities was lower (p < 0.001). The answer "anal muscles" to straining questionnaire showed a strong association with BF response (p < 0.001). A lack in abdominal contraction and in anal relaxation on augmented-DRE were strongly associated with BF response (p < 0.01). Absence of manual maneuvers to facilitate defecation was associated with BF response (p < 0.001).

CONCLUSIONS & INFERENCES

BF is the therapy of choice for refractory constipation due to FDD of any etiology, inducing both clinical and anorectal physiology improvement in the short term. Comorbid IBS-C did not affect outcome while symptomatic isolated pelvic floor abnormalities appeared refractory to behavior treatment. The straining questionnaire and augmented-DRE outcomes showed a strong correlation with BF response and can be implemented in clinical practice to improve the management of constipated patients by prompting early referral to BF.

Role of Sex, Anxiety, and Resilience in the Association Between Adverse Childhood Experiences and Irritable Bowel Syndrome

BACKGROUND & AIMS

Adverse childhood experiences (ACE) are associated with increased risk of irritable bowel syndrome (IBS), a female-predominant chronic abdominal disorder. Factors contributing to this association have not been well-studied. We compared sex differences in ACE for adults with and without IBS and evaluated the impact of anxiety and resilience on the relationship between ACE and IBS.

METHODS

Sex and disease differences in total score and ACE subtypes from the ACE Questionnaire in subjects with IBS and control subjects were assessed. Cross-sectional mediation analysis determined if anxiety (Hospital Anxiety and Depression Scale) and resilience (Connor-Davidson Resilience Scale or Brief Resilience Scale) mediated the relationship between ACE and IBS.

RESULTS

Of 798 participants studied, 368 met IBS diagnostic criteria (265 women, 103 men) and 430 were healthy control subjects (277 women, 153 men). Prevalence and number of ACE were higher in IBS versus control subjects (P < .001) but similar between IBS women and men. Household mental illness increased odds of having IBS in women (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.35-2.85; false discovery rate [FDR], 0.002) and men (OR, 2.32; 95% CI, 1.26-4.33; FDR, 0.014). Emotional abuse increased odds of having IBS in women (OR, 1.94; 95% CI, 1.23-3.09; FDR, 0.019) and sexual abuse increased odds of IBS in men (OR, 3.54; 95% CI, 1.35-10.38; FDR, 0.027). Anxiety mediated 54% (P < .001) of ACE's effect on IBS risk and resilience mediated 12%-14% (Connor-Davidson Resilience Scale, P = .008; Brief Resilience Scale, P = .018).

CONCLUSIONS

Both men and women with a history of ACE are twice as likely to have IBS than those without an ACE. Anxiety mediated the relationship between ACE and IBS in men and women and resilience mediated this relationship only in women.

Validating Simple Modifications to the Rome IV Criteria for the Diagnosis of Irritable Bowel Syndrome in Secondary Care

BACKGROUND

The Rome IV criteria for irritable bowel syndrome (IBS) may be too restrictive for clinical practice and research.

AIMS

To validate the Rome IV criteria and study the diagnostic performance of simple modifications to them.

METHODS

We collected symptom data from consecutive adults with suspected IBS seen in a single clinic. We used a reference standard to confirm IBS (presence of lower abdominal pain associated with altered stool form or frequency; no evidence of organic gastrointestinal disease after limited investigation). We applied Rome IV criteria, but also two modifications. First, we re-incorporated abdominal discomfort but kept symptom frequency required for both abdominal pain and discomfort to at least 1 day per week. Second, we included only abdominal pain but relaxed symptom frequency back to 3 days per month. We calculated sensitivity, specificity and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), for each diagnostic criterion.

RESULTS

We recruited 170 patients (76.5% female, mean age 37.9 years). Sensitivity and specificity of the Rome IV criteria were 82.1% and 85.1%, respectively; positive and negative LRs were 5.51 (95% CI 2.95-11.3) and 0.21 (95% CI 0.14-0.31), respectively. Modifying the criteria by relaxing the frequency of abdominal pain to 3 days per month led to the best performance [sensitivity 90.2%, specificity 85.1%, positive LR 6.06 (95% CI 3.25-12.2), and negative LR 0.11 (95% CI 0.07-0.19)].

CONCLUSIONS

The Rome IV criteria performed well in diagnosing IBS. A simple modification relaxing the required frequency of abdominal pain improved their performance.

Unraveling the genetic susceptibility of irritable bowel syndrome: integrative genome-wide analyses in 845 492 individuals: a diagnostic study

BACKGROUND

Irritable bowel syndrome (IBS) significantly impacts individuals due to its prevalence and negative effect on quality of life. Current genome-wide association studies (GWAS) have only identified a small number of crucial single nucleotide polymorphisms (SNPs), not fully elucidating IBS's pathogenesis.

OBJECTIVE

To identify genomic loci at which common genetic variation influences IBS susceptibility.

METHODS

Combining independent cohorts that in total comprise 65 840 cases of IBS and 788 652 controls, the authors performed a meta-analysis of genome-wide association studies (GWAS) of IBS. The authors also carried out gene mapping and pathway enrichment to gain insights into the underlying genes and pathways through which the associated loci contribute to disease susceptibility. Furthermore, the authors performed transcriptome analysis to deepen their understanding. IBS risk models were developed by combining clinical/lifestyle risk factors with polygenic risk scores (PRS) derived from the GWAS meta-analysis. The authors detect the phenotype association for IBS utilizing PRS-based phenome-wide association (PheWAS) analyses, linkage disequilibrium score regression, and Mendelian randomization.

RESULTS

The GWAS meta-analysis identified 10 IBS risk loci, seven of which were novel (rs12755507, rs34209273, rs34365748, rs67427799, rs2587363, rs13321176, rs1546559). Multiple methods identified nine promising IBS candidate gene ( PRRC2A, COP1, CADM2, LRP1B, SUGT1, MED12L, P2RY14, PHF2, SHISA6 ) at 10 GWAS loci. Transcriptome validation also revealed differential expression of these genes. Phenome-wide associations between PRS-IBS and nine traits (neuroticism, diaphragmatic hernia, asthma, diverticulosis, cholelithiasis, depression, insomnia, COPD, and BMI) were identified. The six diseases (asthma, diaphragmatic hernia, diverticulosis, insomnia major depressive disorder and neuroticism) were found to show genetic association with IBS and only major depressive disorder and neuroticism were found to show causality with IBS.

CONCLUSION

The authors identified seven novel risk loci for IBS and highlighted the substantial influence on genetic risk harbored. The authors' findings offer novel insights into etiology and phenotypic association of IBS and lay the foundation for therapeutic targets and interventional strategies.

Functional Gastrointestinal Disorders and Childhood Obesity: The Role of Diet and Its Impact on Microbiota

Introduction Emerging evidence suggests an association between obesity and Functional Gastrointestinal Disorders (FGIDs). Childhood obesity and FGIDs share many common features, such as high prevalence in the pediatric population, risk factors related to diet and lifestyle, gut microbiota impairments, and psychological distress. This narrative review aims to summarize the main evidence regarding FGIDs in childhood obesity, with a specific focus on the role of diet and its impact on the microbiota. Additionally, the review highlights potential common-ground solutions for preventing and managing both obesity and FGIDs. Methods A comprehensive PubMed search was conducted. Keywords used included terms related to children and adolescents, obesity, functional gastrointestinal disorders, and microbiota. Results The review emphasizes the importance of holistic, multidisciplinary approaches to managing symptoms. In addition to nutrition education, physical activity, and medical care, complementary strategies such as psychological interventions and personalized dietary modifications (e.g., low-FODMAP and fiber-enriched diets) are critical. Given the interplay between gut microbiota alterations, obesity, and FGIDs, microbiota modulation through probiotics, prebiotics, and integrative support shows significant promise. However, the variability in current evidence underlines the need for robust longitudinal studies to develop standardized protocols and maximize treatment efficacy. Conclusions Bridging gaps in knowledge and practice with an integrated, evidence-based framework could improve patient outcomes and deepen understanding of the complex relationship between metabolic and gastrointestinal health in children and adolescents.

Effects of a Footbathing Intervention on Physiological, Endocrine, and Psychological Status in Japanese University Students: A Randomized Controlled Trial

The present pilot study examined effectiveness of a 2-week footbathing intervention on physiological, endocrine, and psychological status in healthy Japanese university students. A total of 51 participants were randomly assigned to a footbathing or normal bathing group. Participants in both groups provided daily free descriptions of their physical and mental states during the intervention period. Participants also underwent measurements of autonomic nervous system activities and salivary cortisol, and completed questionnaires in the pre- and post-intervention periods, as well as in the follow-up period. Neither the footbathing group nor the normal bathing group showed significant changes in deep body temperature, blood pressure, or salivary cortisol through the intervention period. Significant increases in dispositional mindfulness and interoceptive awareness, and significant decrease in trait anxiety were observed regardless of the groups. Nevertheless, an awareness of changes in bodily sensations and mood by footbathing mentioned in the participants' free descriptions was significantly associated with increased deep body temperature, dispositional mindfulness, interoceptive awareness, and subjective well-being from the pre- to post-intervention periods. These results suggest that the period of intervention and sample size might have been insufficient to induce significant changes in baseline psychophysiological status, but that awareness of changes in psychophysiological states may potentially be involved in the mechanism of footbathing.

Evaluation of dietary quality in patients with functional gastrointestinal symptoms: a Norwegian single centre study

Background

Poor dietary quality has been described as a contributor to symptoms in subjects with functional gastrointestinal (GI) symptoms. Hitherto, the focus in dietary evaluation and treatment in this patient group has mainly been on avoiding individual nutrient deficiencies, and less attention has been given to the dietary pattern and the overall food quality. Hence, we aim to describe and evaluate the dietary quality in patients with functional GI symptoms.

Methods

Patients with GI symptoms and a diagnosis of irritable bowel syndrome or inflammatory bowel disease in remission, consecutively referred to a clinical dietitian for nutritional guidance, were included. All participants completed a 7-day weighed food record. The intake of foods, energy, macro- and micronutrients was computed. Dietary quality was evaluated by intake frequencies based on a predefined food index, combined with assessing achievement of nutrient intake recommendations.

Results

A total of 35 patients were included. Intake frequencies of red meat, cheese and sweets were high, whereas intake frequencies of green leafy vegetables, berries, nuts, whole grain and legumes were low. The total intake of vegetables, fruit, berries, fish and nuts was lower than current recommendations, and the intake corresponded to intake below recommendations for several micronutrients, including vitamins D, C and A; iodine; folate; potassium; and selenium.

Conclusion

The group of patients with GI symptoms had overall inadequate dietary quality. Low intake of nutrient-dense food groups considered as beneficial for health corresponded with insufficient intake of several micronutrients. We recommend that dietary evaluation should focus on the intake of food groups, rather than nutrients, in the treatment of patients with functional GI symptoms, to ensure a better evaluation of dietary quality.

Efficacy of acupuncture for functional constipation in elderly: a systematic review and meta-analysis

Background

Numerous clinical studies have shown that patients suffering from functional constipation can benefit by combining medication with acupuncture. There have been no published reviews or meta-analyses regarding the use of acupuncture in treating functional constipation in older adults. Therefore, we carried out a meta-analysis to assess the impact of acupuncture on elderly patients dealing with functional constipation.

Methods

This study retrieved randomized controlled trials (RCTs) on acupuncture therapy for functional constipation in the elderly from several electronic databases, including Embase, PubMed, Cochrane Library, Wanfang Database, Chinese BioMedical Literature Database, and China National Knowledge Infrastructure. In these databases, clinical investigators evaluated the effectiveness of acupuncture as a primary treatment for elderly people with functional constipation. The Cochrane Handbook for Systematic Reviews of Interventions was used by researchers to evaluate the quality of the study.

Results

A total of 469 elderly individuals were included in 8 RCTs. The meta-analysis yielded compelling findings: the application of acupuncture has significantly elevated the rates of treatment effectiveness compared to the control group. Compared with the control group, the treatment group exhibited a statistically significant difference in complete spontaneous bowel movements after treatment. The two groups showed no significant difference in spontaneous bowel movements. However, there was a significant difference in the Bristol Stool Scale scores. The Defecation Difficulty Score and Patient Assessment of Constipation Quality of Life (PAC-QOL) showed p-values that indicated no significant effect. However, acupuncture improved bowel movements, demonstrating a significant difference in the Clinic Constipation Score (CCS) when comparing the two groups. The Nitric Oxide Synthase (NOS) and 5-Hydroxytryptamine (5-HT) contents changed significantly after intervention in both groups. An article reported that the improvement of traditional Chinese medicine (TCM) symptom scores was better in the treatment group than in the control group.

Conclusion

The analysis results indicated that acupuncture can be beneficial for elderly people with functional constipation; however, strong and comprehensive data are not yet obtainable. Given that our study is based on evidence that is of a low-to-moderate quality, further high-quality research is necessary to enhance the feasibility and practicability of this treatment.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024533215.

Rome III and IV criteria are less discordant to diagnose irritable bowel syndrome in clinic patients than in community subjects

BACKGROUND

Though Rome IV criteria for irritable bowel syndrome (IBS) are less sensitive; they select Rome III patients with greater severity and consultation behavior. Since severity of IBS may determine consultation behavior, we compared Rome III and IV criteria in clinic patients and compared with earlier published data from Indian community hypothesizing that the diagnostic discordance between these criteria would be less in clinic than in community.

METHODS

Tertiary clinic patients were screened for IBS using Hindi translated-validated Rome III and IV questionnaires; IBS symptom severity scores (IBS-SSS) was also assessed. Diagnostic discordance between Rome III and IV criteria for IBS was compared with earlier published Indian community data.

RESULTS

Of 110 clinic patients with functional gastrointestinal disorders, 72 met IBS criteria (47 [42.7%], 22 [20%] and three [2.7%] both Rome III and IV criteria, Rome III criteria only and Rome IV criteria only, respectively). In contrast, of 40 IBS subjects from Indian community published earlier, nine (22.5%), 28 (70%) and three (7.5%) fulfilled both Rome III and IV, Rome III only, Rome IV only criteria, respectively. Clinic patients with IBS fulfilling both Rome III and IV criteria or Rome IV criteria had higher IBS-SSS than those fulfilling Rome III criteria only (295.3 ± 80.7 vs. 205.6 ± 65.7; p < 0.00001). This difference was primarily related to pain severity and number of days with pain.

CONCLUSION

Discordance between Rome IV and Rome III criteria in tertiary care clinic patients is less than in community subjects with IBS in India.

Adverse childhood experiences and alexithymia intensity as predictors of temporal dynamics of functioning in individuals with irritable bowel syndrome: A three-wave latent transition analysis

OBJECTIVE

Despite high prevalence of irritable bowel syndrome (IBS) and its significant negative impact on individuals' quality of life, its etiology remains poorly understood. This prospective study explored whether early life factors (adverse childhood experiences; ACEs) and alexithymia intensity, could explain IBS symptom severity and its effects on psychological functioning over time. We also compared the studied variables between an IBS sample and a healthy control group.

METHOD

Based on the Rome III Diagnostic Criteria for IBS, 245 individuals with a diagnosis of IBS were recruited from a national sample of Poles. The IBS sample completed the following psychometric questionaries in three waves, one month apart: Adverse Childhood Experiences Questionnaire, Toronto Alexithymia Scale, IBS Symptom Severity Score, Short Form Perceived Stress Scale, and Ultra-Brief Patient Health Questionnaire for Anxiety and Depression. Latent transition analysis was used to identify distinct profiles of IBS symptom dynamics.

RESULTS

The IBS group reported a significantly higher number of ACEs, greater alexithymia severity, and more intense levels of stress, anxiety, and depressive symptoms compared to the healthy controls. Four profiles of IBS individuals with distinct dynamics of IBS symptoms, stress, anxiety, and depressive symptoms were extracted, which correlated with the baseline number of ACEs and alexithymia intensity among participants.

CONCLUSION

Childhood adversity and associated problems in emotional processing affect IBS symptom severity. ACEs should be included in IBS screening and considered in the design of individualized multidisciplinary treatment approaches for IBS patients.

The Mechanism of Relieving Diarrheal Irritable Bowel Syndrome Using Polyphenols from Ribes nigrum L. Based on a Network Pharmacology Analysis and 16S rRNA Sequencing

Diarrheal irritable bowel syndrome (IBS-D) is a chronic bowel condition that leads to intestinal dysfunction and is typically accompanied by diarrhea, stomach pain, and abdominal distension. Ribes nigrum L. polyphenols (RNPs), which are natural plant polyphenols, are the subject of this study, which aims to assess their potential in improving IBS-D and to explore the underlying mechanisms through a network pharmacology analysis and 16S rRNA sequencing. Next, mice models of diarrhea-predominant irritable bowel were established, and the mice with IBS-D were treated with RNPs. The effect of RNPs was then evaluated in terms of body weight, abdominal withdrawal reflex (AWR), Bristol score, fecal water percentage, diluted fecal volume, total intestinal transit time, immune index, histopathological observation, and changes in inflammatory factors. Finally, 16S rRNA sequencing and reverse q-RTPCR were utilized to evaluate the components that mediate the impact of RNPs on IBS-D. It was found that when RNP treatment was administered to mice with IBS-D, they decreased the water content in their stools, raised their immunological scores, and decreased the amount of inflammatory substances in their bodies. Moreover, through 16S rRNA sequencing, it was shown that the RNP treatment increased the relative abundances of Bacteroides, Alloprevotella, and Alistipes, which led to the remodeling of gut microbiota. In summary, RNPs significantly improved the conditions of mice with IBS-D by inhibiting the FoxO pathway and enhancing gut microbiota. This study concludes that RNPs could significantly improve the symptoms of mice with IBS-D through these means.

Dietary Intake and Quality in Irritable Bowel Syndrome: A Comparative Study With Controls and the Association With Symptom Severity

INTRODUCTION

Patients with irritable bowel syndrome (IBS) often attribute the onset or worsening of gastrointestinal symptoms to intake of food. Hence, to alleviate symptoms, patients with IBS may avoid triggering foods, potentially impacting their dietary intake and diet quality. This study aimed to compare the habitual diet intake and quality of patients with IBS with controls and to explore the association between dietary habits and symptoms in patients with IBS.

METHODS

Patients with IBS were included in 4 clinical studies reporting habitual dietary intakes at baseline. Age- and sex-matched controls representing the general population were derived from the Swedish population-based Riksmaten study. Dietary intakes were assessed using 4-day food diaries. Diet quality was measured using the diet quality index-Swedish national dietary guidelines (DQI-SNR), and diet diversity was scored based on the variety of food groups consumed.

RESULTS

The study included 646 patients with IBS and 646 controls (38 ± 14 years, 77% female). Both groups adhered to Nordic nutrition recommendations for macronutrients, except patients consumed fewer carbohydrates. Patients reported eating less carbohydrates, coffee, and dairy products and more fats, lactose-free dairy products, and nuts and seeds compared with controls. Fewer patients had a good diet quality according to the DQI-SNR. In patients, symptom severity and gastrointestinal-specific anxiety were associated with reduced energy and carbohydrate intake, lower diet diversity, and worse diet quality. Poor diet quality was associated with younger age, more severe IBS symptoms, anxiety, and depression.

DISCUSSION

Patients with IBS exhibit different dietary patterns compared with controls, with poorer dietary habits linked to more severe symptoms. Understanding food-symptom associations may enhance the optimization and personalization of dietary management for patients with IBS.

Comparison of the Bristol Stool Scale and Modified Version for Children: Use by Providers vs Children

INTRODUCTION

Accurate report of stool form is essential to diagnosis and assessment of treatment response. The modified Bristol Stool Form Scale for Children (mBSFS-C) classifies stool form into 5 types and is reliable and valid. However, a direct comparison of provider's and children's ratings using the mBSFS-C vs the traditional BSFS that uses 7 stool form types has not been done.

METHODS

Pediatric gastroenterology providers and children rated the same 35 stool photographs, reflecting diverse stool forms, using both scales. The order of photograph presentation and scale use were randomized. For each photograph, the most common rating (modal rating) was calculated for both scales and study samples. The percentage of child and provider ratings matching their respective modal ratings was determined.

RESULTS

Twenty-one providers (21 faculty, 11 fellows, 3 nurse practitioners) and 200 children (mean age 12 ± 3 years) participated. No order effect (mBSFS-C vs BSFS used first) was observed. Of 1,225 provider ratings using the mBSFS-C, 90.0% agreed with the provider's modal ratings vs 77.8% using the BSFS. Of 7,000 child ratings using the mBSFS-C, 84.6% agreed with the children's modal ratings vs 71.8% using the BSFS. Using providers' modal ratings as the reference, all mBSFS-C photograph modal ratings matched between children and providers (35/35 photographs) whereas only 86% (30/35 photographs) matched with the BSFS.

DISCUSSION

(i) The mBSFS-C showed greater modal agreement among both providers and children compared with the BSFS, and (ii) provider-child concordance was greater with the mBSFS-C than with the BSFS. Validation in other regions/populations is needed.

Microbiome Shifts and Their Impact on Gut Physiology in Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders characterized by recurrent abdominal pain and altered bowel habits. The exact pathophysiological mechanisms for IBS development are not completely understood. Several factors, including genetic predisposition, environmental and psychological influences, low-grade inflammation, alterations in gastrointestinal motility, and dietary habits, have been implicated in the pathophysiology of the disorder. Additionally, emerging evidence highlights the role of gut microbiota in the pathophysiology of IBS. This review aims to thoroughly investigate how alterations in the gut microbiota impact physiological functions such as the brain-gut axis, immune system activation, mucosal inflammation, gut permeability, and intestinal motility. Our research focuses on the dynamic "microbiome shifts", emphasizing the enrichment or depletion of specific bacterial taxa in IBS and their profound impact on disease progression and pathology. The data indicated that specific bacterial populations are implicated in IBS, including reductions in beneficial species such as Lactobacillus and Bifidobacterium, along with increases in potentially harmful bacteria like Firmicutes and Proteobacteria. Emphasis is placed on the imperative need for further research to delineate the role of specific microbiome alterations and their potential as therapeutic targets, providing new insights into personalized treatments for IBS.

Prevalence of irritable bowel syndrome in endometriosis patients: A cross-sectional study

Background

Despite its prevalence, limited research has explored the direct correlation between irritable bowel syndrome (IBS) and endometriosis, particularly in regions like Saudi Arabia. This study aimed to bridge this gap by investigating the prevalence of IBS among endometriosis patients and identifying associated risk factors.

Materials and Methods

The study conducted a cross-sectional analysis, it was done at King Abdulaziz University Hospital, Jeddah. From September to December 2023. Women who were diagnosed with endometriosis and aged above 18 years old were included.

Results

Our study revealed that 47.8% of endometriosis patients had previously been diagnosed with IBS. Interestingly, Saudi patients exhibited a significantly higher prevalence of IBS compared to non-Saudi individuals. While no substantial link emerged between IBS prevalence and other demographic or endometriosis-related factors, patients with chronic digestive conditions like food intolerance, esophageal reflux, and inflammatory colon diseases showed a higher likelihood of IBS.

Conclusions

This study underscores a substantial association between IBS and endometriosis, urging healthcare providers to consider IBS as a potential comorbidity in affected patients. The findings stress the importance of holistic assessments and awareness regarding overlapping symptoms and risk factors. Further research is encouraged to unveil underlying mechanisms and devise optimal management strategies for individuals grappling with both conditions.

Probiotic and prebiotic interventions in eating disorders: A narrative review

AIMS

The review aimed to summarise and discuss findings focused on therapeutic probiotic and prebiotic interventions in eating disorders (ED).

METHODS

Using PubMed/MEDLINE, Cochrane Library, and Web of Science all published studies were retrieved until February 2023, following PRISMA guidelines. From the 111 initial studies, 5 met the inclusion criteria for this review.

RESULTS

All studies included in this narrative review were focused on anorexia nervosa (AN). Three longitudinal, randomised, controlled trials aimed to evaluate interventions with probiotics (Lactobacillus reuteri, yoghurt with Lactobacillus, and Streptococcus) in children and adolescents. These studies primarily emphasised medical outcomes and anthropometric measures following the administration of probiotics. However, the findings yielded mixed results in terms of short-term weight gain or alterations in specific immunological parameters. With a lower level of evidence, supplementation with synbiotics (probiotic + prebiotic) has been associated with improvements in microbiota diversity and attenuation of inflammatory responses.

CONCLUSIONS

Research on probiotics and prebiotics in ED is limited, primarily focussing on anorexia nervosa (AN). Their use in AN regarding medical and anthropometric outcomes needs further confirmation and future research should be warranted to assess their impact on psychological and ED symptomatology, where there is a notable gap in the existing literature.