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von dem Knesebeck O, Löwe B, Lüdecke D, Bobardt JS, Barbek R. Public knowledge and beliefs about the irritable bowel syndrome - results from the SOMA.SOC study. BMC Public Health 2024; 24:219. [PMID: 38238839 PMCID: PMC10797779 DOI: 10.1186/s12889-024-17784-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Despite the epidemiological and economic relevance of the irritable bowel syndrome (IBS), there is a lack of research on what the general public knows and thinks about this condition (IBS literacy). Therefore, the aim of this study was to explore public knowledge and beliefs about IBS in Germany. Moreover, associations of knowledge and beliefs about IBS with socio-demographic characteristics as well as illness and treatment experiences were analysed. METHODS Analyses made use of a national telephone survey (N = 1,205). A carefully developed vignette describing a person with typical symptoms of IBS was presented. Respondents were then asked to name the disease in question and beliefs about causes and treatment options were assessed. For the analyses respondents were divided into three groups: (1) people who never had IBS symptoms, (2) people who had or have IBS symptoms but never were in treatment and (3) individuals who reported to be or have been treated for IBS symptoms. RESULTS Less than 4% of the respondents recognized IBS after presentation of the vignette. About 75% positively evaluated treatability while psychotherapy was evaluated more effective than medication. Stress and unhealthy lifestyle were the most frequently endorsed possible causes of the presented IBS symptoms. There were variations in knowledge and beliefs about IBS according to age, gender, and education. We found minor differences in beliefs and knowledge between individuals who had or have symptoms but never were in treatment and those without respective illness experience. Respondents with illness/treatment experiences rated their knowledge significantly better than those without any experiences. CONCLUSIONS Results indicate low levels of public knowledge about IBS regarding illness recognition in Germany. A majority disagreed that they have good knowledge about IBS symptoms. Against this background, it seems reasonable to develop and test interventions to improve IBS literacy by increasing knowledge about symptoms, causes and treatment options.
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Affiliation(s)
- Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Martinstr.52, 20246, Hamburg, Germany.
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, UKE, Hamburg, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Martinstr.52, 20246, Hamburg, Germany
| | - Johanna S Bobardt
- Department of General Practice and Primary Care, UKE, Hamburg, Germany
| | - Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Martinstr.52, 20246, Hamburg, Germany
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Khalil TA, Filmban DM, Sinnah HNM, Fallatah RA, Sayis AA, Alruwaili SS, Alghamdi SA, Almutairi NFM, Haider AMI, Ajam RA, Basmih AF. Knowledge, Attitude, and Practices Regarding the Rome IV Criteria for the Diagnosis of Irritable Bowel Syndrome Among Primary Healthcare Physicians in Saudi Arabia. Cureus 2023; 15:e49460. [PMID: 38152827 PMCID: PMC10751600 DOI: 10.7759/cureus.49460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) presents a significant challenge in the medical field due to its complex nature as a functional gastrointestinal illness (FGID) without clear biological markers. Diagnosis often involves ruling out other potential causes, leading to frustration for patients and difficulty in effective treatment. Given its high prevalence among FGIDs, primary healthcare (PHC) physicians play a crucial role in its initial assessment and management. METHODS This cross-sectional study surveyed 623 PHC physicians using a structured, closed-ended questionnaire. Employing a multistage sampling approach, physicians were selected from various provinces and cities in Saudi Arabia. Clusters within these cities were also sampled. RESULTS The research revealed that a majority of physicians (n = 411, 66%) exhibited a strong awareness of the Rome IV criteria, essential for diagnosing IBS. This awareness correlated significantly with variables, such as age, nationality, marital status, specialty, classifications, and years of experience. CONCLUSION PHC physicians in the study demonstrated a commendable level of familiarity with the Rome IV criteria for diagnosing IBS. Their knowledge was particularly robust concerning symptoms outlined in these criteria. However, there is room for improvement in their understanding, attitude, and application of the Rome IV guidelines in practice. Addressing these gaps could enhance the overall management of IBS cases by these physicians.
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Affiliation(s)
- Tahani A Khalil
- Family Medicine, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | | | | | - Asmaa A Sayis
- Internal Medicine, Al-Noor Specialist Hospital, Mecca, SAU
| | | | | | | | | | - Razan A Ajam
- Faculty of Medicine, Ibn Sina National College, Jeddah, SAU
| | - Abeer F Basmih
- Internal Medicine, Al-Noor Specialist Hospital, Mecca, SAU
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Abusageah F, Hakami A, Zogel B, Zaalah S, Alfaifi S, Shubayli S, Hakami K, Qadah E, Aldharman S, Hakami F, Alqasemi M, Mobarki M, Alhazmi AH. A Cross-Sectional Study about Knowledge, Attitude, and Practices among Primary Health Care Physicians in Jazan Province, Saudi Arabia, Regarding Rome IV Criteria for Diagnosis of Irritable Bowel Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121811. [PMID: 36557013 PMCID: PMC9785885 DOI: 10.3390/medicina58121811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Background and objectives: Most individuals with irritable bowel syndrome (IBS) are diagnosed by primary health care (PHC) physicians. However, a significant percentage of patients remain undiagnosed or misdiagnosed owing to the lack of knowledge or a systematic strategy regarding the use of ROME IV criteria for the diagnosis of IBS. Thus, in this study, we aimed to assess the knowledge, attitude, and practices among primary health care physicians in Jazan Province, Saudi Arabia, regarding ROME IV criteria for the diagnosis of IBS. Methods: A cross-sectional study was conducted using a pretested self-administered questionnaire that determines participants' sociodemographic data and measures knowledge about ROME IV criteria, targeting PHC physicians in Jazan Province, Saudi Arabia. Data were analyzed using the Statistical Package for Social Sciences (SPSS) v.23. Results: We included 200 participants, and the majority of participants in our study (approximately 78%) were aware of the ROME IV diagnostic criteria for IBS; this awareness was associated with age, nationality, specialty, and classification. The participants' mean level of knowledge was 4.30 (out of 6). However, knowledge was higher among Saudi and family medicine doctors in this study, as compared to non-Saudi and doctors of other specialties. More than two-thirds of participants who were aware of ROME IV criteria thought that they are sufficient to diagnose IBS; however, only 47.5% of physicians reported using ROME IV frequently in their daily practice. Conclusions: Most of the participants of this study are aware of ROME IV criteria, and better knowledge was noted among Saudi and family medicine physicians. About 70% thought that ROME IV criteria are effective enough to diagnose IBS, and only about half of the participants use ROME IV criteria in their practice. Therefore, due to its high prevalence in the region, further efforts are required to disseminate basic knowledge and improve attitudes and practices related to ROME IV criteria among PHC physicians of all specialties.
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Affiliation(s)
- Faisal Abusageah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Alwaleed Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Basem Zogel
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Shaden Zaalah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Samar Alfaifi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Sahar Shubayli
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Khalid Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Entsar Qadah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Sarah Aldharman
- Faculty of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Faisal Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Maram Alqasemi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mousa Mobarki
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Abdulaziz H. Alhazmi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
- Correspondence: ; Tel.: +966-7329-5000
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Carbone F, Van den Houte K, Besard L, Tack C, Arts J, Caenepeel P, Piessevaux H, Vandenberghe A, Matthys C, Biesiekierski J, Capiau L, Ceulemans S, Gernay O, Jones L, Maes S, Peetermans C, Raat W, Stubbe J, Van Boxstael R, Vandeput O, Van Steenbergen S, Van Oudenhove L, Vanuytsel T, Jones M, Tack J. Diet or medication in primary care patients with IBS: the DOMINO study - a randomised trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute. Gut 2022; 71:2226-2232. [PMID: 35483886 PMCID: PMC9554021 DOI: 10.1136/gutjnl-2021-325821] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND In Europe, IBS is commonly treated with musculotropic spasmolytics (eg, otilonium bromide, OB). In tertiary care, a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet provides significant improvement. Yet, dietary treatment remains to be explored in primary care. We evaluated the effect of a smartphone FODMAP-lowering diet application versus OB on symptoms in primary care IBS. METHODS IBS patients, recruited by primary care physicians, were randomised to 8 weeks of OB (40 mg three times a day) or diet and followed for 24 weeks. We compared IBS Symptom Severity Score and the proportion of responders (improvement ≥50 points) in all patients and the subgroup fulfilling Rome IV criteria (Rome+). We also evaluated treatment efficacy, quality of life, anxiety, depression, somatic symptom severity (Patient Health Questionnaire (PHQ15, PHQ9)) and treatment adherence and analysed predictors of response. RESULTS 459 primary care IBS patients (41±15 years, 76% female, 70% Rome+) were randomised. The responder rate after 8 weeks was significantly higher with diet compared with OB (71% (155/218) vs 61% (133/217), p=0.03) and more pronounced in Rome+ (77% (118/153) vs 62% (98/158), p=0.004). Patients allocated to diet (199/212) were 94% adherent compared with 73% with OB (148/202) (p<0.001). The significantly higher response rate with diet was already observed after 4 weeks (62% (132/213) vs 51% (110/215), p=0.02) and a high symptom response persisted during follow-up. Predictors of response were female gender (OR=2.08, p=0.04) for diet and PHQ15 (OR=1.10, p=0.02) for OB. CONCLUSION In primary care IBS patients, a FODMAP-lowering diet application was superior to a spasmolytic agent in improving IBS symptoms. A FODMAP-lowering diet should be considered the first-line treatment for IBS in primary care. TRIAL REGISTRATION NUMBER NCT04270487.
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Affiliation(s)
- Florencia Carbone
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Karen Van den Houte
- TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Linde Besard
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Céline Tack
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Joris Arts
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,Gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Philip Caenepeel
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,Gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Hubert Piessevaux
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Christophe Matthys
- Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jessica Biesiekierski
- TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium.,Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Luc Capiau
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Steven Ceulemans
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Olivier Gernay
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Lydia Jones
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Sophie Maes
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Christian Peetermans
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Willem Raat
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jeroen Stubbe
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Rudy Van Boxstael
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Olivia Vandeput
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | | | - Lukas Van Oudenhove
- TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Michael Jones
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jan Tack
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium .,TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium.,Rome Foundation Research Institute, Raleigh, North Carolina, USA.,Rome Foundation, Raleigh, North Carolina, USA
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Kovács DB, Szekely A, Hubai AG, Palsson O. Prevalence, epidemiology and associated healthcare burden of Rome IV irritable bowel syndrome and functional dyspepsia in the adult population of Gibraltar. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-000979. [PMID: 35953148 PMCID: PMC9379472 DOI: 10.1136/bmjgast-2022-000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Gibraltar is a unique densely populated multicultural British Overseas Territory for which no population data on disorders of gut–brain interaction have existed. We aimed to provide the first-ever assessment of prevalence of irritable bowel syndrome and functional dyspepsia in Gibraltar in relation to their diagnostic recognition and healthcare burden. Design An internet survey was carried out in Gibraltar in 2019–2020. The study survey included demographic questions, the Rome IV diagnostic questions for functional dyspepsia and irritable bowel syndrome, relevant medical history, previous surgeries, medication use, healthcare visit frequency and a quality-of-life questionnaire. Results 888 individuals (3.5% of all Gibraltar adults) completed the survey anonymously. Irritable bowel syndrome prevalence was 5.2% (95% CI 3.7% to 6.6%). Functional dyspepsia prevalence was 9.9% (95% CI 7.9% to 11.9%). The two conditions overlapped substantially. Women had higher mean prevalence than men of both disorders. People meeting criteria for either or both disorders were prone to surgeries, had more frequent healthcare visits, higher medication use and lower quality-of-life scores compared with people without these disorders. Diagnostic recognition by healthcare providers was low, leaving 58.3% of irritable bowel syndrome and 96.9% of functional dyspepsia individuals undiagnosed. Conclusion This first-ever population-based study of Rome IV defined irritable bowel syndrome and functional dyspepsia in Gibraltar indicates that the prevalence rates of these disorders are similar to the recently reported data for the UK and Spain, but they remain poorly recognised despite substantially affecting the quality of life of individuals who have them in the Gibraltar community.
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Affiliation(s)
- Dénes Botond Kovács
- Department of General Surgery, Gibraltar Health Authority, Gibraltar, Gibraltar
| | - Andrea Szekely
- Mental Health Department, Gibraltar Health Authority, Gibraltar, Gibraltar
| | | | - Olafur Palsson
- Division of Gastroenterology and Hepatology Center for Functional GI and Motility Disorders, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Translational Gap between Guidelines and Clinical Medicine: The Viewpoint of Italian General Practitioners in the Management of IBS. J Clin Med 2022; 11:jcm11133861. [PMID: 35807145 PMCID: PMC9267465 DOI: 10.3390/jcm11133861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/05/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
Irritable bowel syndrome (IBS) guidelines are generally developed by experts, with the possibility of a translational gap in clinical medicine. The aim of our study was to assess an Italian group of general practitioners (GPs) for their awareness and use of criteria for the diagnosis and management of IBS. For this purpose, a survey was carried out involving 235 GPs, divided into two groups according to their years of activity: 65 “junior general practitioners” (JGPs) (≤10 years) and 170 “senior general practitioners” (SGPs) (>10 years). JGPs were more familiar with the Rome IV Criteria and Bristol Scale than SGPs. Abdominal pain, bowel movement frequency and bloating were the symptoms most frequently used to make a diagnosis. The most probable causes of IBS were reported to be abnormal gastrointestinal motility and psychological triggers. SGPs reported more frequently than JGPs that challenging management and patient’s request were motivations for a gastroenterological consultation. The practice of clinical medicine is still far from the guidelines provided by the specialists. Abdominal pain related to defecation and changes in bowel frequency are considered to be the more important symptoms for IBS diagnosis, but most GPs, both JGPs and SGPs, like to consider abdominal bloating as another useful symptom. Involving both gastroenterologists and GPs in developing shared guidelines would be highly desirable in order to improve IBS management strategies in everyday clinical practice.
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Effective Communication Strategies and Tools for Improving Treatment Outcomes in Patients With Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation. Am J Gastroenterol 2022; 117:S14-S20. [PMID: 35354771 DOI: 10.14309/ajg.0000000000001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 12/11/2022]
Abstract
Patients with chronic idiopathic constipation and irritable bowel syndrome with constipation experience an array of gastrointestinal symptoms. Given the subjective nature of these disorders, patient self-reporting is critical to diagnosis and monitoring response to therapy. Unfortunately, many patients are reluctant to discuss bowel symptoms with their healthcare providers. Differences in sex, health literacy, and age can influence symptom reporting. Negative patient-physician relationships and dissatisfaction with care lead patients to seek alternative treatments, switch healthcare providers, or discontinue care. Thus, adopting a patient-centered communication style can help create a shared understanding of patients' symptoms, achieve accurate symptom reporting, expedite diagnosis, and facilitate appropriate treatment plans. Currently, there are multiple symptom and quality-of-life scales available to assist healthcare providers in this endeavor. These scales also allow for the monitoring of constipation-related symptoms and symptom severity. When using patient self-assessments to measure treatment responses, scale selection may depend on the number of symptoms being assessed, the duration and frequency of assessments, and patients' comprehension and language skills.
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Reuzé A, Delvert R, Perrin L, Benamouzig R, Sabaté JM, Bouchoucha M, Allès B, Touvier M, Hercberg S, Julia C, Kesse-Guyot E. Association between Self-Reported Gluten Avoidance and Irritable Bowel Syndrome: Findings of the NutriNet-Santé Study. Nutrients 2021; 13:4147. [PMID: 34836402 PMCID: PMC8622067 DOI: 10.3390/nu13114147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Self-management of irritable bowel syndrome (IBS) is increasingly focusing on exclusion diets. In particular; patients are showing a significant interest in the gluten-free diet for the treatment of IBS. However; the lack of scientific evidence prevents the establishment of clear dietary guidelines and attention is needed as dietary restriction can lead to potentially adverse effects. This cross-sectional study aims to explore the practice of gluten avoidance in participants identified with IBS in a large cohort of non-celiac French adults. The population included 15,103 participants of the NutriNet-Santé study who completed a functional gastrointestinal disorder questionnaire based on the Rome III criteria to identify IBS in 2013 and a food avoidance questionnaire in 2016. Data on diet and anthropometric and sociodemographic characteristics were collected. Multivariate logistic regression models were used to compare the avoidance of gluten between IBS and non-IBS participants. Participants were mainly women (73.4%) and the mean age in this population was 55.8 ± 13.2 years. Among these individuals, 804 (5.4%) participants were identified as IBS cases. Among them, the prevalence of gluten avoidance was estimated at 14.8%, of which 3.0% reported total avoidance; versus 8.8% and 1.6% in non-IBS participants. After adjustments; gluten avoidance was higher in IBS participants compared to their non-IBS counterparts: (OR = 1.86; 95%CI = 1.21, 2.85) for total and (OR = 1.71; 95%CI = 1.36, 2.14) for partial avoidance. Participants identified with IBS were more associated with gluten avoidance than non-IBS participants. Further studies are needed to explore the long-term consequences of dietary interventions and to provide consistent dietary guidance connected to patient perception.
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Affiliation(s)
- Anouk Reuzé
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inrae U1125, Cnam, Université Sorbonne Paris Nord University, 93017 Bobigny, France; (R.D.); (L.P.); (B.A.); (M.T.); (S.H.); (C.J.); (E.K.-G.)
| | - Rosalie Delvert
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inrae U1125, Cnam, Université Sorbonne Paris Nord University, 93017 Bobigny, France; (R.D.); (L.P.); (B.A.); (M.T.); (S.H.); (C.J.); (E.K.-G.)
| | - Laëtitia Perrin
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inrae U1125, Cnam, Université Sorbonne Paris Nord University, 93017 Bobigny, France; (R.D.); (L.P.); (B.A.); (M.T.); (S.H.); (C.J.); (E.K.-G.)
| | - Robert Benamouzig
- Department of Hepatology and Gastroenterology, Avicenne Hospital (AP-HP), 93017 Bobigny, France; (R.B.); (J.-M.S.); (M.B.)
| | - Jean-Marc Sabaté
- Department of Hepatology and Gastroenterology, Avicenne Hospital (AP-HP), 93017 Bobigny, France; (R.B.); (J.-M.S.); (M.B.)
- Physiopathologie et Pharmacologie Clinique de la Douleur, Ambroise Paré Hospital, 92104 Boulogne Billancourt, France
| | - Michel Bouchoucha
- Department of Hepatology and Gastroenterology, Avicenne Hospital (AP-HP), 93017 Bobigny, France; (R.B.); (J.-M.S.); (M.B.)
| | - Benjamin Allès
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inrae U1125, Cnam, Université Sorbonne Paris Nord University, 93017 Bobigny, France; (R.D.); (L.P.); (B.A.); (M.T.); (S.H.); (C.J.); (E.K.-G.)
| | - Mathilde Touvier
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inrae U1125, Cnam, Université Sorbonne Paris Nord University, 93017 Bobigny, France; (R.D.); (L.P.); (B.A.); (M.T.); (S.H.); (C.J.); (E.K.-G.)
| | - Serge Hercberg
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inrae U1125, Cnam, Université Sorbonne Paris Nord University, 93017 Bobigny, France; (R.D.); (L.P.); (B.A.); (M.T.); (S.H.); (C.J.); (E.K.-G.)
- Department of Public Health, Avicenne Hospital (AP-HP), 93017 Bobigny, France
| | - Chantal Julia
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inrae U1125, Cnam, Université Sorbonne Paris Nord University, 93017 Bobigny, France; (R.D.); (L.P.); (B.A.); (M.T.); (S.H.); (C.J.); (E.K.-G.)
- Department of Public Health, Avicenne Hospital (AP-HP), 93017 Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inrae U1125, Cnam, Université Sorbonne Paris Nord University, 93017 Bobigny, France; (R.D.); (L.P.); (B.A.); (M.T.); (S.H.); (C.J.); (E.K.-G.)
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Nulsen B, LeBrett W, Drossman DA, Chang L. A survey of gastroenterologists in the United States on the use of central neuromodulators for treating irritable bowel syndrome. Aliment Pharmacol Ther 2021; 54:281-291. [PMID: 34148256 DOI: 10.1111/apt.16467] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/16/2021] [Accepted: 05/23/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Central neuromodulators are an effective treatment for irritable bowel syndrome (IBS) but may be used less frequently than other therapies. AIMS To survey gastroenterologists in the United States (US) about their use of neuromodulators in patients with IBS. METHODS A 23-question survey was distributed to gastroenterologists in the United States. Comparisons in prescribing practices were conducted between (a) gastroenterologists who were "high prescribers" versus "low prescribers" of neuromodulators in patients with IBS and (b) gastroenterologists and "gastroenterology experts" in the use of neuromodulators using descriptive statistics and multivariable logistic regression analyses. RESULTS The 525 gastroenterologists who were surveyed used neuromodulators for a median range of 21%-30% of their patients with IBS. Neuromodulators were described as extremely/very important in managing IBS by 55% of clinicians. Significant predictors of high-prescribing behaviour were academic versus clinical practice setting (odds ratio [OR] 2.60 [95% CI 1.61-4.20]), disorders of brain-gut interaction focused practice (OR 4.80 [2.60-8.84]), and greater perceived effectiveness of neuromodulators (OR 2.75 [1.30-5.84]). Compared to gastroenterologists, experts prescribed neuromodulators to a higher percentage of their patients with IBS (41%-50% vs 21%-30%; P = 0.019) and more frequently found neuromodulators effective (70% vs 27%; P = 0.003). However, concern about side effects was the most common barrier to neuromodulator use (59%). CONCLUSIONS The majority of US gastroenterologists believe central neuromodulators are important in treating IBS, and 27% believe they are effective in most patients. High prescribers are in academic practice, focus in IBS and perceive central neuromodulators as effective. Education is needed to improve gastroenterologists' prescribing behaviour.
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Affiliation(s)
- Benjamin Nulsen
- Department of Medicine and Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Wendi LeBrett
- Department of Medicine and Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Douglas A Drossman
- Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, University of North Carolina, Chapel Hill, NC, USA
| | - Lin Chang
- Department of Medicine and Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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10
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Pemberton L, Kita L, Andrews K. Practitioners' experiences of using Gut Directed Hypnosis for irritable bowel syndrome: Perceived impact upon client wellbeing: A qualitative study. Complement Ther Med 2020; 55:102605. [PMID: 33220622 DOI: 10.1016/j.ctim.2020.102605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022] Open
Abstract
Gut Directed Hypnosis (GDH) is a specialised form of hypnotherapy originally developed to reduce gastrointestinal (GI) symptoms in individuals with Irritable Bowel Syndrome (IBS). IBS is a condition characterised by symptoms including bloating, abdominal pain and diarrhoea and/or constipation as well as psychosocial symptoms such as depression and anxiety. Although the specific mechanism of action remains unclear, it is suggested that GDH works on the brain-gut axis to improve GI symptoms, psychological functioning and overall wellbeing. The present study aimed to expand upon the knowledge surrounding GDH by exploring practitioners' experiences of using GDH for IBS and their perceptions of how it impacts upon client wellbeing. Six practitioners trained in GDH participated in one hour semi-structured interviews. Thematic Analyses (TA) was used to analyse data. Three major themes emerged from data including: predisposing personality traits and vulnerabilities associated with IBS; GDH as evidence-based practice; and the future evolution of GDH. The findings from this study add to the growing body of literature exploring the use of GDH for IBS, by incorporating the perspective of practitioners working within this field.
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Affiliation(s)
| | - Lauren Kita
- Australian College of Applied Psychology, Australia
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11
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White LS, Campbell C, Lee A, Lord A, Radford-Smith G. Intestinal ultrasound as first-line investigation in low-risk gastrointestinal symptoms: a new model of care. Intern Med J 2020; 52:95-99. [PMID: 33197118 DOI: 10.1111/imj.15133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Functional gut disorders (FGD) are common. Diagnosis is symptom based, although symptoms may be indistinguishable from inflammatory bowel disease. As a result of this, investigations are common, diagnostic yield is low. A streamlined novel model of care may reduce costly investigations. AIM To compare a new model of care for patients with low-risk gastrointestinal symptoms to a matched historical cohort. METHODS Data were prospectively collected over 12 months. General practitioner referrals for low-risk abdominal symptoms were triaged to a new multidisciplinary clinic structure utilising intestinal ultrasound. Outcomes were compared to the historical model in the preceding 12 months. Duration of care (time from referral to discharge), number of contact episodes and investigations ordered were reviewed. RESULTS Thirty-seven patients meeting strict inclusion criteria completed their care. Compared with the historical cohort, colonoscopies reduced from 0.7 to 0.05 per patient (P < 0.0001). Gastroenterology consults reduced from 1.5 to 1.2 (P = 0.303) and dietitian review increased from 0.8 to 1.5 (P < 0.0001). Total contact episodes reduced from 3.2 to 1.8 (P < 0.0001). Duration of care reduced from a median of 252 days to 130 days (interquartile ranges (IQR) 287 and 69, respectively; P < 0.0001). Time from first consultation to discharge reduced from 125 to 42 days (IQR 188 and 63; P < 0.0001). CONCLUSION This multidisciplinary approach to care of low-risk abdominal symptoms significantly reduced contact episodes, time in care and invasive investigations. It decreased costly gastroenterology consultation and increased allied health exposure. It demonstrates improved health service outcomes.
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Affiliation(s)
- Lauren S White
- Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.,Department of Gastroenterology and Hepatology, Royal Brisbane Womens Hospital, Brisbane, Queensland, Australia.,Gut Health Group, QIMR Berghofer, Brisbane, Queensland, Australia
| | - Caitlin Campbell
- Department of Gastroenterology and Hepatology, Royal Brisbane Womens Hospital, Brisbane, Queensland, Australia
| | - Andrew Lee
- Department of Gastroenterology and Hepatology, Royal Brisbane Womens Hospital, Brisbane, Queensland, Australia
| | - Anton Lord
- Department of Gastroenterology and Hepatology, Royal Brisbane Womens Hospital, Brisbane, Queensland, Australia.,Gut Health Group, QIMR Berghofer, Brisbane, Queensland, Australia
| | - Graham Radford-Smith
- Department of Gastroenterology and Hepatology, Royal Brisbane Womens Hospital, Brisbane, Queensland, Australia.,Gut Health Group, QIMR Berghofer, Brisbane, Queensland, Australia
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12
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Austhof E, Schaefer K, Faulkner J, Bach L, Riddle M, Pogreba-Brown K. Knowledge and practices of primary care physicians or general practitioners treating post-infectious Irritable Bowel Syndrome. BMC Gastroenterol 2020; 20:159. [PMID: 32450813 PMCID: PMC7249359 DOI: 10.1186/s12876-020-01305-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
Background Post-infectious Irritable Bowel Syndrome (PI-IBS) is a functional bowel disorder which has significant impacts to a patient’s quality of life. No IBS-specific biomarker or treatment regimen for PI-IBS currently exists, therefore understanding practice patterns and variance is of interest. Methods This online survey of primary care physicians and general practitioners in the USA aimed to understand the knowledge and treatment of PI-IBS within the physician’s current practice. Summary statistics are provided with a commentary on implications for practices and treatment of PI-IBS. Results Most physician survey respondents (n = 50) were aware of PI-IBS, but less than half discussed this condition as a possible outcome in their patients with a recent gastrointestinal infection. Most physicians indicated that they would treat the patients themselves with a focus on managing IBS through different treatment modalities based on severity. Treatment for PI-IBS followed IBS recommendations, but most physicians also prescribed a probiotic for therapy. Physicians estimated that 4 out of 10 patients who develop PI-IBS will have life-long symptoms and described significant impacts to their patient’s quality of life. Additionally, physicians estimated a significant financial burden for PI-IBS patients, ranging from $100–1000 (USD) over the course of their illness. Most physicians agreed that they would use a risk score to predict the probability of their patients developing PI-IBS, if available. Conclusions While this survey is limited due to sample size, physician knowledge and treatment of PI-IBS was consistent across respondents. Overall, the physicians identified significant impacts to patient’s quality of life due to PI-IBS.
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Affiliation(s)
- Erika Austhof
- Department of Epidemiology & Biostatistics, University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, PO Box 245211, Tucson, 85721, AZ, USA.
| | - Kenzie Schaefer
- Department of Epidemiology & Biostatistics, University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, PO Box 245211, Tucson, 85721, AZ, USA.,College of Medicine, University of Arizona, 1501 N Campbell Ave, PO Box 245017, Tucson, 85724, AZ, USA
| | - Jaime Faulkner
- College of Medicine, University of Arizona, 1501 N Campbell Ave, PO Box 245017, Tucson, 85724, AZ, USA
| | - Laura Bach
- Division of Gastroenterology and Hepatology, College of Medicine, University of Arizona, 1501 N Campbell Ave, PO Box 245028, Tucson, 85724, AZ, USA
| | - Mark Riddle
- School of Medicine, University of Nevada Reno, 1664 N Virginia Street, Reno, 89557, NV, USA
| | - Kristen Pogreba-Brown
- Department of Epidemiology & Biostatistics, University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, PO Box 245211, Tucson, 85721, AZ, USA
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13
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Agnello M, Carroll LN, Imam N, Pino R, Palmer C, Varas I, Greene C, Hitschfeld M, Gupta S, Almonacid DE, Hoaglin MC. Gut microbiome composition and risk factors in a large cross-sectional IBS cohort. BMJ Open Gastroenterol 2020; 7:e000345. [PMID: 32518661 PMCID: PMC7254124 DOI: 10.1136/bmjgast-2019-000345] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/30/2019] [Accepted: 01/09/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that is difficult to diagnose and treat due to its inherent heterogeneity and unclear aetiology. Although there is evidence suggesting the importance of the microbiome in IBS, this association remains poorly defined. In the current study, we aimed to characterise a large cross-sectional cohort of patients with self-reported IBS in terms of microbiome composition, demographics, and risk factors. Design Individuals who had previously submitted a stool sample for 16S microbiome sequencing were sent a comprehensive survey regarding IBS diagnosis, demographics, health history, comorbidities, family history, and symptoms. Log ratio-transformed abundances of microbial taxa were compared between individuals reporting a diagnosis of IBS without any comorbidities and individuals reporting no health conditions. Univariable testing was followed by a multivariable logistic regression model controlling for relevant confounders. Results Out of 6386 respondents, 1692 reported a diagnosis of IBS without comorbidities and 1124 reported no health conditions. We identified 3 phyla, 15 genera, and 19 species as significantly associated with IBS after adjustment for confounding factors. Demographic risk factors include a family history of gut disorders and reported use of antibiotics in the last year. Conclusion The results of this study confirm important IBS risk factors in a large cohort and support a connection for microbiome compositional changes in IBS pathogenesis. The results also suggest clinical relevance in monitoring and investigating the microbiome in patients with IBS. Further, the exploratory models described here provide a foundation for future studies.
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Affiliation(s)
| | | | | | | | | | | | - Claire Greene
- Medical Affairs, uBiome, San Francisco, California, USA
| | | | - Sarah Gupta
- Medical Affairs, uBiome, San Francisco, California, USA
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14
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Münch A, Sanders DS, Molloy-Bland M, Hungin APS. Undiagnosed microscopic colitis: a hidden cause of chronic diarrhoea and a frequently missed treatment opportunity. Frontline Gastroenterol 2020; 11:228-234. [PMID: 32419914 PMCID: PMC7223274 DOI: 10.1136/flgastro-2019-101227] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/30/2019] [Accepted: 06/20/2019] [Indexed: 02/04/2023] Open
Abstract
Microscopic colitis (MC) is a treatable cause of chronic, non-bloody, watery diarrhoea, but physicians (particularly in primary care) are less familiar with MC than with other causes of chronic diarrhoea. The colon in patients with MC is usually macroscopically normal. MC can only be diagnosed by histological examination of colonic biopsies (subepithelial collagen band >10 µm (collagenous colitis) or >20 intraepithelial lymphocytes per 100 epithelial cells (lymphocytic colitis), both with lamina propria inflammation). The UK National Health Service exerts downward pressure to minimise colonoscopy referrals. Furthermore, biopsies are often not taken according to guidelines. These factors work against MC diagnosis. In this review, we note the high incidence of MC (comparable to ulcerative colitis and Crohn's disease) and its symptomatic overlap with irritable bowel syndrome. We also highlight problems with the recommendation by National Health Service/National Institute for Health and Care Excellence guidelines for inflammatory bowel diseases that colonoscopy referrals should be based on a faecal calprotectin level of ≥100 µg/g. Faecal calprotectin is <100 µg/g in over half of individuals with active MC, building into the system a propensity to misdiagnose MC as irritable bowel syndrome. This raises important questions-how many patients with MC have already been misdiagnosed, and how do we address this silent burden? Clarity is needed around pathways for MC management; MC is poorly acknowledged by the UK healthcare system and it is unlikely that best practices are being followed adequately. There is an opportunity to identify and treat patients with MC more effectively.
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Affiliation(s)
- Andreas Münch
- Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - David S Sanders
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | | | - A Pali S Hungin
- The Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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15
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Predictors of Health-related Quality of Life in Irritable Bowel Syndrome Patients Compared With Healthy Individuals. J Clin Gastroenterol 2019; 53:e142-e149. [PMID: 29351154 PMCID: PMC6051929 DOI: 10.1097/mcg.0000000000000978] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) reduces health-related quality of life (HRQOL). It is unclear how having IBS modifies the impact of gastrointestinal (GI), psychosocial, and somatic symptom variables on HRQOL compared with healthy controls (HCs). AIMS (1) Determine psychosocial, somatic, and physical status variables most predictive of HRQOL in IBS and HCs and (2) determine if IBS status modifies relationships between predictive factors and HRQOL. METHODS IBS patients and HCs completed validated questionnaires measuring GI symptoms, psychosocial/somatic variables, and physical [physical component score (PCS)] and mental [mental component score (MCS)] HRQOL via the Short-Form-36. Associations between these variables and HRQOL were evaluated with multiple linear regressions. Variables were standardized to determine the strongest predictors of HRQOL. Statistical significance level was 0.01. RESULTS Mean HRQOL was higher in 417 HCs versus 290 IBS subjects (PCS: 55.6 vs. 48.6, P<0.001; MCS: 53.7 vs. 44.8, P<0.001). The GI symptom measures were negatively associated with PCS in IBS, but only usual severity was associated with MCS (P<0.01). In all subjects, psychosocial and somatic measures were associated with MCS and not PCS excluding GI symptom anxiety, which correlated with both (P<0.01). The strongest predictor of MCS was perceived stress in IBS and depression symptoms in HCs. GI symptom anxiety was the strongest predictor of PCS in both. Greater perceived stress and somatic symptom severity and less mindfulness was linked to larger reductions in HRQOL for IBS compared with HCs (P<0.01). CONCLUSIONS GI symptom severity and anxiety correlate with PCS, whereas psychosocial/somatic measures parallel MCS. However, HRQOL is comparable in IBS and HCs when perceived stress, somatic symptom severity, and mindfulness are at optimal levels. These findings may have important implications in the management of IBS.
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16
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Schomacker ML, Hansen KE, Ramlau-Hansen CH, Forman A. Is endometriosis associated with irritable bowel syndrome? A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2018; 231:65-69. [DOI: 10.1016/j.ejogrb.2018.10.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/05/2018] [Accepted: 10/07/2018] [Indexed: 01/22/2023]
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17
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Bai T, Wang WF, Zhang L, Wang H, Qian W, Song J, Hou XH. Positive endoscopic and ultrasonographic findings in patients with symptom-diagnosed functional gastrointestinal disorder: Data from a Chinese cross-sectional study. J Dig Dis 2018; 19:759-765. [PMID: 30520233 DOI: 10.1111/1751-2980.12693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/15/2018] [Accepted: 11/22/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Few studies have systematically assessed symptom-based diagnoses of functional gastrointestinal disorders (FGID) in China. This study aimed to evaluate the positive endoscopic and ultrasonographic findings in patients with symptom-based FGID. METHODS Adult patients with gastrointestinal symptoms but not red flag symptoms who were empirically diagnosed with FGID underwent an upper or lower gastrointestinal endoscopy. An abdominal ultrasonography was also performed to screen for potential organic diseases. Patients' data were collected and the Rome III questionnaire was used for symptom-based assessment. RESULTS Positive endoscopic and ultrasonographic findings were detected in 31.8%, 26.2% and 9.9% of patients with esophageal, gastroduodenal and intestinal disorders, respectively. Among patients diagnosed with FGID using the questionnaire, the rates of positive endoscopic and ultrasonographic findings were higher in patients with upper gastrointestinal symptoms than in those with lower gastrointestinal symptoms. Moreover, patients elder than 34.5 years with upper gastrointestinal symptoms and those elder than 47.5 years with lower gastrointestinal symptoms were more likely to have positive endoscopic and ultrasonographic findings. CONCLUSIONS The Rome III questionnaire is a valuable diagnostic tool for screening FGID in China. However, the rates of positive endoscopic and ultrasonographic findings vary depending on the location of symptoms. Endoscopy and ultrasonography have irreplaceable value, especially for investigating upper gastrointestinal symptoms.
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Affiliation(s)
- Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wen Feng Wang
- Department of Gastroenterology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, Guangdong Province, China
| | - Lei Zhang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Huan Wang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wei Qian
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Song
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Hua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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18
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Linedale EC, Mikocka-Walus A, Vincent AD, Gibson PR, Andrews JM. Performance of an algorithm-based approach to the diagnosis and management of functional gastrointestinal disorders: A pilot trial. Neurogastroenterol Motil 2018; 30. [PMID: 29094806 DOI: 10.1111/nmo.13243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/04/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent advances in the development of diagnostic criteria and effective management options for functional gastrointestinal disorders (FGIDs) have not yet been integrated into clinical practice. There is a clear need for the development and validation of a simple clinical pathway for the diagnosis and management of FGIDs which can be used in primary care. METHODS In this controlled pilot study, we designed and evaluated a non-specialist-dependent, algorithm-based approach for the diagnosis and management of FGIDs (ADAM-FGID). Patients referred to 1 tertiary referral center with clinically suspected functional gastrointestinal disorders were allocated to waitlist control or algorithm group. The algorithm group was screened for organic disease, and those without clinical alarms received a written FGID diagnosis and management options. All participants were followed up for 1 year. KEY RESULTS The ADAM-FGID was found to be feasible and acceptable to both patients and primary healthcare providers. The diagnostic component identified that 39% of referrals required more urgent gastroenterological review than original triage category, with organic disease subsequently diagnosed in 31% of these. The majority of patients (82%) diagnosed with a FGID did not receive a relevant alternative diagnosis during follow-up. Patient buy-in to the model was good, with all reading the diagnostic/management letter, 80% entering management, and 61% reporting symptom improvement at 6 weeks. Moreover, 68% of patients and all referring doctors found the approach to be at least moderately acceptable. Patients reported being reassured by the approach and found the management options useful. Primary healthcare providers acknowledged the potential of this approach to reduce waiting times for endoscopic procedures and to provide reassurance to both patients and themselves. CONCLUSIONS & INFERENCES This pilot study provides preliminary evidence to support a clinical pathway for the diagnosis and management of FGIDs which does not depend upon specialist review. Further rigorous testing within primary care is needed to conclusively establish safety and efficacy. However, this approach is safer than current management and has potential to build capacity by reducing specialist burden and expediting effective care.
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Affiliation(s)
- E C Linedale
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - A Mikocka-Walus
- School of Psychology, Deakin University, Burwood, Vic., Australia
| | - A D Vincent
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, Adelaide, SA, Australia
| | - P R Gibson
- Department of Gastroenterology Alfred Hospital, Monash University, Melbourne Vic, Australia
| | - J M Andrews
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology Alfred Hospital, Monash University, Melbourne Vic, Australia
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19
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Linedale EC, Shahzad MA, Kellie AR, Mikocka‐Walus A, Gibson PR, Andrews JM. Referrals to a tertiary hospital: A window into clinical management issues in functional gastrointestinal disorders. JGH Open 2017; 1:84-91. [PMID: 30483542 PMCID: PMC6207011 DOI: 10.1002/jgh3.12015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/27/2017] [Accepted: 09/03/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM To investigate the quality of and reasons for referrals of patients with likely functional gastrointestinal disorders (FGID) and explore patients' experience of clinical management. METHODS A cross sectional, mixed-methods study was undertaken. Referrals (July 2013-2015) to one gastroenterology outpatient department triaged as "likely FGID", the referred patients and their referring primary healthcare providers were examined. RESULTS A total of 69% of patients reported not yet receiving an initial diagnosis, 52% reported persistent/distressing symptoms or reduced quality of life, 24% feared missed or worsening pathology, and 35% were seeking repeat specialist consultation. Most patients were dissatisfied (40%) or only partially satisfied (36%) with current management. Dissatisfaction was significantly related to the lack of provision of a diagnosis and effective treatment options (P < 0.001). Referral quality was poor and with the reason for referral clearly communicated in only 25%. Common referral reasons included repeat presentations (n = 32), diagnostic uncertainty (n = 19), to ensure nothing is missed (n = 19), patient request (n = 17), no response to treatment (n = 16), and to allay patient fears (n = 14). A total of 28/60 primary healthcare providers were confident that their patient had a FGID, yet sought confirmation (n = 16), second opinion (n = 8), or advice (n = 4). CONCLUSION Current management of FGID in usual care is suboptimal, as evidenced by the tertiary referral load, patient dissatisfaction, and the lack of provision of diagnoses and effective treatment options. Some clinicians lack confidence in effectively identifying and managing these conditions. Resources and supports to equip and assist clinicians to identify and manage FGID successfully may enhance patient care.
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Affiliation(s)
- Ecushla C Linedale
- Department of Medicine, The University of AdelaideAdelaideSouth AustraliaAustralia
| | - Muhammad A Shahzad
- Department of Gastroenterology and Hepatology, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Andrew R Kellie
- GP Clinic, East Adelaide Health CareAdelaideSouth AustraliaAustralia
| | - Antonina Mikocka‐Walus
- Department of Medicine, The University of AdelaideAdelaideSouth AustraliaAustralia
- School of Psychology, Deakin UniversityBurwoodVictoriaAustralia
| | - Peter R Gibson
- Department of Gastroenterology, Monash UniversityClaytonVictoriaAustralia
| | - Jane M Andrews
- Department of Medicine, The University of AdelaideAdelaideSouth AustraliaAustralia
- Department of Gastroenterology and Hepatology, Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
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20
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Chandar AK. Diagnosis and treatment of irritable bowel syndrome with predominant constipation in the primary-care setting: focus on linaclotide. Int J Gen Med 2017; 10:385-393. [PMID: 29184433 PMCID: PMC5673039 DOI: 10.2147/ijgm.s126581] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a complex functional gastrointestinal disorder that is exceedingly common in clinical practice. IBS with predominant constipation (IBS-C) is a subtype of IBS that accounts for more than a third of the IBS diagnosed. Diagnosis of IBS requires a careful personalized approach, a comprehensive clinical history, limited but relevant investigations, and continued follow-up. Major IBS societies and guidelines recommend offering a positive diagnosis of IBS based on presenting symptomatology. Abdominal pain that may or may not be relieved by defecation is the cardinal symptom of IBS; distension and bloating are other common symptoms. Careful attention should be paid to alarm symptoms before a diagnosis of IBS is made. Pharmacotherapy with linaclotide is recommended for moderate-severe IBS-C, based on high-quality evidence from randomized controlled trials. Diarrhea is the major side effect of linaclotide, and limited cost-effectiveness data currently exist.
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Affiliation(s)
- Apoorva Krishna Chandar
- Department of Gastroenterology and Liver Disease, Case Western Reserve University
- Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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21
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Linedale EC, Andrews JM. Diagnosis and management of irritable bowel syndrome: a guide for the generalist. Med J Aust 2017; 207:309-315. [PMID: 28954618 DOI: 10.5694/mja17.00457] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/03/2017] [Indexed: 12/13/2022]
Abstract
Irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGIDs) are so prevalent they cannot reasonably have their diagnoses and management based within specialty care. However, delayed diagnosis, lengthy wait times for specialist review, overinvestigation and lack of clear diagnostic communication are common. The intrusive symptoms of IBS and other FGIDs impair patient functioning and reduce quality of life, and come with significant costs to individual patients and the health care system, which could be reduced with timely diagnosis and effective management. IBS, in particular, is no longer a diagnosis of exclusion, and there are now effective dietary and psychological therapies that may be accessed without specialist referral. The faecal calprotectin test is widely available, yet not on the Medical Benefits Schedule, and a normal test result reliably discriminates between people with IBS and patients who warrant specialist referral.
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Use of Rome criteria for the diagnosis of irritable bowel syndrome in primary care: a survey among European countries. Eur J Gastroenterol Hepatol 2017; 29:651-656. [PMID: 28125426 DOI: 10.1097/meg.0000000000000848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES The majority of patients with irritable bowel syndrome (IBS) are diagnosed and treated in primary care. The aim of this study was to investigate the implementation of the Rome criteria in daily primary care clinical practice and adherence of general practitioners (GPs) to recommended diagnostic approaches for IBS. PATIENTS AND METHODS A survey consisting of 18 questions was distributed across 11 European countries and was used to assess GPs' diagnostic approach of IBS, the use of Rome criteria in daily practice and GPs' perspective on the aetiology of the disorder. RESULTS Overall, 185 GPs completed the survey. In daily clinical practice, 32% of GPs reported that they usually make a positive diagnosis on the basis of symptoms only, whereas 36% of GPs reported regular use of the Rome criteria to diagnose IBS. Furthermore, 62% of the responders reported that they applied additional diagnostics, such as blood tests, 31% found it necessary to perform endoscopy to make a positive diagnosis of IBS and 29% referred patients with IBS to a specialist. Psychological factors were the most frequently selected potential aetiological factor of IBS (88% of GPs). Overall, 52% of GPs reported systematically including questions on psychological symptoms in the assessment of history of IBS. CONCLUSION Only about one-third of GPs regularly used the Rome criteria to diagnose IBS. In daily primary care practice, IBS largely remains a diagnosis of exclusion. This has implications in terms of GPs' specialty training and questions the applicability of IBS guidelines in daily care, which advocate an early, positive, symptom-based diagnosis.
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Skrastins O, Fletcher PC. "One Flare at a Time": Adaptive and Maladaptive Behaviors of Women Coping With Inflammatory Bowel Disease and Irritable Bowel Syndrome. CLIN NURSE SPEC 2017; 30:E1-E11. [PMID: 27509570 DOI: 10.1097/nur.0000000000000229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this investigation is to study the lived experiences of female postsecondary students diagnosed with inflammatory bowel disease and/or irritable bowel syndrome. METHODS Nine women between the ages of 18 and 26 years were recruited to participate in this study. Participants completed an informed consent form and background questionnaire before completing a semi-structured one-on-one interview. This interview explored the lived experiences of these individuals in relation to condition management. RESULTS Three salient themes that emerged from the data included (1) it can add to my life; (2) why me: my condition runs my life; and (3) I'm doing the best I can with what I have. The salient theme of I'm doing the best I can with what I have, the theme addressed in this article, was subdivided into adaptive and maladaptive coping behaviors. Reasons for the use of these behaviors included to avoid triggers or flare-ups/harmful effects, to achieve instant relief/pleasure, to respond to environmental pressures, and to become accustomed to dealing with the everyday hassles of their conditions. CONCLUSION Community health nurses may become part of the solution to help women with inflammatory bowel disease and irritable bowel syndrome find more adaptive coping behaviors. Other implications are discussed.
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Affiliation(s)
- Olivia Skrastins
- Author Affiliations: Undergraduate Student (Ms Skrastins); Professor and Graduate Coordinator (Dr Fletcher), Department of Kinesiology, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Uncertain Diagnostic Language Affects Further Studies, Endoscopies, and Repeat Consultations for Patients With Functional Gastrointestinal Disorders. Clin Gastroenterol Hepatol 2016; 14:1735-1741.e1. [PMID: 27404968 DOI: 10.1016/j.cgh.2016.06.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/05/2016] [Accepted: 06/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although guidelines state that functional gastrointestinal disorders (FGIDs) can be diagnosed with minimal investigation, consultations and investigations still have high costs. We investigated whether these are due to specific behaviors of specialist clinicians by examining differences in clinician approaches to organic gastrointestinal diseases vs FGIDs. METHODS We performed a retrospective review of 207 outpatient department letters written from the gastroenterology unit at a tertiary hospital after patient consultations from 2008 through 2011. We collected data from diagnostic letters and case notes relating to patients with organic (n = 108) or functional GI disorders (n = 119). We analyzed the content of each letter by using content analysis and reviewed case files to determine which investigations were subsequently performed. Our primary outcome was the type of diagnostic language used and other aspects of the clinical approach. RESULTS We found gastroenterologists to use 2 distinct types of language, clear vs qualified, which was consistent with their level of certainty (or lack thereof), for example, "the patient is diagnosed with…." vs "it is possible that this patient might have….". Qualified diagnostic language was used in a significantly higher proportion of letters about patients with FGIDs (63%) than organic gastrointestinal diseases (13%) (P < .001). In addition, a higher proportion of patients with FGIDs underwent endoscopic evaluation than patients with organic gastrointestinal diseases (79% vs 63%; P < .05). CONCLUSIONS In an analysis of diagnoses of patients with FGIDs vs organic disorders, we found that gastroenterologists used more qualified (uncertain) language in diagnosing patients with FGIDs. This may contribute to patient discard of diagnoses and lead to additional, unwarranted endoscopic investigations.
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Emmanuel A, Landis D, Peucker M, Hungin APS. Faecal biomarker patterns in patients with symptoms of irritable bowel syndrome. Frontline Gastroenterol 2016; 7:275-282. [PMID: 27761231 PMCID: PMC5036220 DOI: 10.1136/flgastro-2015-100651] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/08/2016] [Accepted: 02/12/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To determine rates of faecal biomarker results capable of suggesting potentially treatable causes of irritable bowel syndrome (IBS) symptomatology in a population of patients with symptoms of IBS who meet Rome III criteria for that condition. DESIGN Descriptive, retrospective study in which faecal biomarker results (dichotomised into 'normal' and 'abnormal' values) were related to data from patient-completed questionnaire data identifying demographics, Rome III criteria for IBS and IBS phenotype (IBS-D, IBS-C, IBS-M and IBS-U). SETTING Commercial reference laboratory. PATIENTS Individuals whose physicians ordered faecal biomarker testing for evaluation of chronic abdominal symptoms consistent with IBS. INTERVENTIONS None. MAIN OUTCOME MEASURES Rates of occurrence of abnormal results on any of seven faecal biomarkers suggesting a treatable cause for IBS symptoms. RESULTS Abdominal symptoms meeting Rome III criteria for IBS were present in 3553 records (the population), which were subjected to further analysis. Abnormal biomarker results (the outcomes) occurred in 94% of cases; 73% and 65% of records indicated growth of a bacterial potential pathogen and low growth of beneficial organisms, respectively. Abnormal results for all other faecal biomarkers occurred with frequencies from 5% to 13%. Frequency of abnormal results for elastase, calprotectin, eosinophil protein X, and beneficial organisms rose significantly with age, and differed significantly across IBS phenotypes. CONCLUSIONS A large proportion of patients manifesting symptoms meeting Rome III IBS diagnostic criteria have faecal biomarker results indicating potential underlying, treatable causes of their symptoms. Faecal biomarker testing is an appropriate means of identifying potentially treatable causes of IBS symptoms.
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Affiliation(s)
- Anton Emmanuel
- GI Physiology Unit, University College Hospital, London, UK
| | - Darryl Landis
- Medical Affairs, Genova Diagnostics, Inc., Asheville, North Carolina, USA
| | | | - A Pali S Hungin
- School of Medicine, Pharmacy and Health, Wolfson Research Institute, Queen's Campus, Durham University, Stockton on Tees, UK
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Cash BD. Eluxadoline: a promising therapy that raises many questions. Transl Gastroenterol Hepatol 2016; 1:76. [PMID: 28138642 PMCID: PMC5244598 DOI: 10.21037/tgh.2016.09.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 09/05/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Brooks D Cash
- Gastroenterology Division, University of South Alabama, Mobile, AL 36688, USA
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Foxx-Orenstein AE. New and emerging therapies for the treatment of irritable bowel syndrome: an update for gastroenterologists. Therap Adv Gastroenterol 2016; 9:354-75. [PMID: 27134665 PMCID: PMC4830102 DOI: 10.1177/1756283x16633050] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Irritable bowel syndrome is a functional bowel disorder with gastrointestinal symptoms (e.g. abdominal pain, straining, urgency, incomplete evacuation, nausea, and bloating) that occur alongside bowel function alterations (i.e. constipation, diarrhea, or both). Patients with irritable bowel syndrome may also experience comorbid anxiety and depression. Irritable bowel syndrome is common, with a prevalence estimated between 3% and 28%, affecting patient health and quality of life. Patients with moderate or severe irritable bowel syndrome generally seek medical care, whereas those with milder symptoms may choose self-management. Most patients with irritable bowel syndrome receive outpatient care, but irritable bowel syndrome-related hospitalizations do occur. The pathophysiology of irritable bowel syndrome is multifactorial (i.e. genetics, immune components, changes in the gut microbiota, disturbances in physiologic stress response systems, and psychosocial factors). Management of irritable bowel syndrome can include lifestyle changes, dietary interventions, counseling, psychologic medication, and agents that affect gastrointestinal motility. A number of therapies have emerged in recent years with clinical trial data demonstrating efficacy and safety for patients with irritable bowel syndrome, including agents that target gastrointestinal motility (i.e. linaclotide), gastrointestinal opioid receptors (i.e. asimadoline, eluxadoline), and gut microbiota (i.e. rifaximin). Linaclotide has been shown to significantly improve stool frequency and abdominal pain compared with placebo in constipation-predominant irritable bowel syndrome (number needed to treat, 5.1). Asimadoline shows efficacy in patients with moderate-to-severe irritable bowel syndrome-related pain. Rifaximin provided adequate relief of global irritable bowel syndrome symptoms versus placebo for a significantly greater percentage of patients with diarrhea-predominant irritable bowel syndrome (p < 0.001). Management that encompasses all aspects of irritable bowel syndrome (gastrointestinal symptoms) and comorbid psychologic symptoms (e.g. anxiety or depression) is important for improving overall patient health and well-being.
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Affiliation(s)
- Amy E. Foxx-Orenstein
- Mayo Clinic Division of Gastroenterology and Hepatology, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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Hungin APS, Paxman L, Koenig K, Dalrymple J, Wicks N, Walmsley J. Prevalence, symptom patterns and management of episodic diarrhoea in the community: a population-based survey in 11 countries. Aliment Pharmacol Ther 2016; 43:586-95. [PMID: 26749499 DOI: 10.1111/apt.13513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 05/13/2015] [Accepted: 12/11/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The extent of episodic diarrhoea in the community is relatively unknown. AIM To ascertain the prevalence, symptoms and management behaviours associated with self-reported diarrhoea across 11 countries. METHODS Community screening surveys were conducted using quota sampling of respondents to identify a nationally representative sample of individuals suffering from 'episodic' diarrhoea (occurring once a month or more often). Second-phase in-depth surveys provided data on epidemiology, symptoms, attributed causes and management of episodic diarrhoea. RESULTS A total of 11 508 phase 1 and 6613 phase 2 surveys were completed. The prevalence of self-reported episodic diarrhoea ranged from 16% to 23% across the 11 countries. The majority of episodic diarrhoea sufferers were female (57%) and were not diagnosed with pre-existing irritable bowel syndrome (IBS); IBS diagnosis ranged from 9% in Mexico to 44% in Italy. Diarrhoea was frequently attributed to anxiety/stress, food-related causes, gastrointestinal 'sensitivity' and menstruation. Accompanying symptoms included 'stomach pain/cramping' (35-62%), 'stomach grumbling' (29-68%) and 'wind' (18-74%). The proportion of episodic sufferers who reported treating their symptoms with remedies or medications ranged between 46% in Belgium and Canada and 90% in Mexico. CONCLUSIONS A substantial proportion of the population in middle- to high-income countries report episodic diarrhoea in the absence of a pre-existing diagnosis. These symptoms are likely to be associated with substantial social and economic costs, and have implications on how best to configure and guide self-led, pharmacist-led and primary care management.
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Affiliation(s)
- A P S Hungin
- School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Stockton-on-Tees, UK
| | | | - K Koenig
- Johnson & Johnson Ltd, Maidenhead, UK
| | - J Dalrymple
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - N Wicks
- Right Medicine Pharmacy Ltd., Stirling, Scotland
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Lan C, Sun XN, Zhou XC, Yang B, Huang BL, Deng TZ, He ZT, Han XY. Preinduced intestinal HSP70 improves visceral hypersensitivity and abnormal intestinal motility in PI-IBS mouse model. ASIAN PAC J TROP MED 2016; 9:302-5. [DOI: 10.1016/j.apjtm.2016.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 12/20/2015] [Accepted: 12/30/2015] [Indexed: 12/24/2022] Open
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Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology 2016; 150:S0016-5085(16)00223-7. [PMID: 27144617 DOI: 10.1053/j.gastro.2016.02.032] [Citation(s) in RCA: 1161] [Impact Index Per Article: 145.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 12/02/2022]
Abstract
Functional gastrointestinal disorders (FGIDs), the most common diagnoses in gastroenterology are recognized by morphological and physiological abnormalities that often occur in combination including motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota and altered central nervous system processing. Research on these gut-brain interaction disorders is based on using specific diagnostic criteria. The Rome Foundation has played a pivotal role in creating diagnostic criteria thus operationalizing the dissemination of new knowledge in the field of FGIDs. Rome IV is a compendium of the knowledge accumulated since Rome III was published 10 years ago. It improves upon Rome III by: 1) updating the basic and clinical literature, 2) offering new information on gut microenvironment, gut-brain interactions, pharmacogenomics, biopsychosocial, gender and cross cultural understandings of FGIDs, 3) reduces the use of imprecise and occassionally stigmatizing terms when possible, 4) uses updated diagnostic algorithms, 5) incorporates information on the patient illness experience, and physiological subgroups or biomarkers that might lead to more targeted treatment. This introductory article sets the stage for the remaining 17 articles that follow and offers an historical overview of the FGIDs field, differentiates FGIDs from motility and structural disorders, discusses the changes from Rome III, reviews the Rome committee process, provides a biopsychosocial pathophysiological conceptualization of FGIDs, and offers an approach to patient care.
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Cash BD, Lacy BE, Rao T, Earnest DL. Rifaximin and eluxadoline - newly approved treatments for diarrhea-predominant irritable bowel syndrome: what is their role in clinical practice alongside alosetron? Expert Opin Pharmacother 2015; 17:311-22. [PMID: 26559529 DOI: 10.1517/14656566.2016.1118052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Diarrhea-predominant irritable bowel syndrome (IBS-D) is a common functional gastrointestinal condition in which patients experience abdominal pain, diarrhea, bloating, cramps, flatulence, fecal urgency, and incontinence. AREAS COVERED We review two recently approved therapies that focus on treating underlying pathogenic mechanisms of IBS-D: (1) the non-absorbable antibiotic rifaximin, and (2) the opioid receptor agonist/antagonist eluxadoline. We compare the safety and efficacy data emerging from rifaximin and eluxadoline registration trials with safety and efficacy data from the alosetron clinical development program. EXPERT OPINION The rifaximin and eluxadoline clinical development programs for IBS-D have demonstrated significant improvement in IBS-D endpoints compared to placebo. Direct comparison of primary endpoint results from the alosetron, rifaximin, and eluxadoline pivotal trials is not possible; however, general estimates of efficacy can be made, and these demonstrate similar and significantly greater responses to 'adequate relief' and a composite endpoint of abdominal pain/stool form for each agent compared to placebo. With the recent approval in the United States of rifaximin and eluxadoline for IBS-D, how should clinicians employ these agents? We suggest that they be utilized sequentially, taking into consideration patient symptoms and severity, prior medical history, mode of action, cost, availability, managed care coverage, and adverse event profiles.
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Affiliation(s)
- Brooks D Cash
- a Gastroenterology Division , University of South Alabama , Mobile , AL , USA
| | - Brian E Lacy
- b Division of Gastroenterology & Hepatology , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA
| | - Tharaknath Rao
- c Clinical Development & Medical Affairs , Prometheus Laboratories Inc ., San Diego , CA , USA
| | - David L Earnest
- c Clinical Development & Medical Affairs , Prometheus Laboratories Inc ., San Diego , CA , USA
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Zhou XC, Sun XN, Yang B, Huang BL, Deng TZ, He ZT, Han XY, Lan C. Expression of heat shock protein 70 in intestinal tissue of mice with post-infectious irritable bowel syndrome. Shijie Huaren Xiaohua Zazhi 2015; 23:4177-4183. [DOI: 10.11569/wcjd.v23.i26.4177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To detect the expression of heat shock protein 70 (HSP70) in intestinal tissue of mice with post-infectious irritable bowel syndrome (PI-IBS).
METHODS: A mouse model for PI-IBS was established by infection of mice with trichinella spiralis in vivo. The inflammatory score of the intestine of PI-IBS mice was calculated, and abdominal withdrawal reflex (AWR) and colon transportation test (CTT) were used to evaluate the clinical features of the PI-IBS mice. Intestinal expression of HSP70 was measured by immunohistochemistry. Spearman correlation analysis was carried out to assess the relationship between the expression of HSP70 and the clinical features of PI-IBS.
RESULTS: The PI-IBS mouse model was established successfully. On the 8th week, there was no visible inflammation in the intestine (ileal inflammation score: P > 0.05), whereas the clinical features significantly changed, including increased AWR score (P < 0.01) and decreased CTT score (P < 0.01). The expression of HSP70 significantly increased in the ileum but not in the colon of PI-IBS mice at the 8th week (ileum: P < 0.01; colon: P > 0.05). The expression of HSP70 in the ileum, but not in the colon, was remarkably related with the clinical features of PI-IBS mice, including the negative relationship with AWR (P < 0.01), and the positive relationship with CTT (P < 0.01).
CONCLUSION: HSP70 might be associated with low-grade intestinal inflammation induced visceral hypersensitivity and abnormal intestinal motility in mice with PI-IBS.
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Michalsen VL, Vandvik PO, Farup PG. Predictors of health-related quality of life in patients with irritable bowel syndrome. A cross-sectional study in Norway. Health Qual Life Outcomes 2015. [PMID: 26223784 PMCID: PMC4518561 DOI: 10.1186/s12955-015-0311-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Reduced quality of life (QoL) is often the main problem for patients with irritable bowel syndrome (IBS). This study aimed at finding predictors of reduced physical and mental quality of life (QoL) accessible for intervention. Methods Consecutive patients with IBS (according to the Rome II criteria) visiting a general practitioner were included in a prospective cohort study and followed up for 6−9 months. At the last visit, information about sociodemographic characteristics, abdominal complaints, QoL and a range of physical and mental comorbidities were collected. Physical and mental QoL were measured with the generic QoL instrument Short Form-12 Physical Component Score (SF-12 PCS) and Short Form-12 Mental Component Score (SF-12 MCS) respectively. The normal scores are 50. This cross-sectional study used data from the last visit. Results Out of 208 patients included in the cohort study, 149 (female/male: 105/44) with a mean age of 52 years (SD 15.3) were available for the analyses. Physical and mental QoL were reduced, the mean SF-12 PCS and SF-12 MCS scores were 38.4 (SD 11.9) and 45.0 (SD 11.3) respectively. The main independent predictors of low SF-12 PCS and SF-12 MCS were subjective health complaints and organic diseases, and affective disorders respectively. The severity of IBS symptoms was of minor clinical importance. Conclusions To help patients with IBS and reduced QoL, treatment should focus on QoL and not on relief of IBS symptoms. The different causes of reduced physical and mental QoL make an individually directed treatment necessary.
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Affiliation(s)
- Vilde Lehne Michalsen
- Department of Research, Innlandet Hospital Trust, N-2381, Brumunddal, Norway. .,Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, N-7491, Trondheim, Norway.
| | - Per Olav Vandvik
- Department of Medicine, Innlandet Hospital Trust, N-2819, Gjøvik, Norway.
| | - Per G Farup
- Department of Research, Innlandet Hospital Trust, N-2381, Brumunddal, Norway. .,Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, N-7491, Trondheim, Norway.
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Affiliation(s)
- Pamela J Hornby
- Janssen Research & Development, Cardiovascular and Metabolic Disease, Janssen Pharmaceutical Companies of Johnson and Johnson, SH42-2508-A, 1400 McKean Road, Spring House, PA 19477, USA
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Slattery SA, Niaz O, Aziz Q, Ford AC, Farmer AD. Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea. Aliment Pharmacol Ther 2015; 42:3-11. [PMID: 25913530 DOI: 10.1111/apt.13227] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 03/23/2015] [Accepted: 04/10/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Irritable bowel syndrome is a widespread disorder with a marked socioeconomic burden. Previous studies support the proposal that a subset of patients with features compatible with diarrhoea-predominant IBS (IBS-D) have bile acid malabsorption (BAM). AIM To perform a systematic review and meta-analysis to assess the prevalence of BAM in patients meeting the accepted criteria for IBS-D. METHODS MEDLINE and EMBASE were searched up to March 2015. Studies recruiting adults with IBS-D, defined by the Manning, Kruis, Rome I, II or III criteria and which used 23-seleno-25-homotaurocholic acid (SeHCAT) testing for the assessment of BAM were included. BAM was defined as 7 day SeHCAT retention of <10%. We calculated the rate of BAM and 95% confidence intervals (CI) using a random effects model. The methodological quality of included studies was evaluated using the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2). RESULTS The search strategy identified six relevant studies comprising 908 individuals. The rate of BAM ranged from 16.9% to 35.3%. The pooled rate was 28.1% (95% CI: 22.6-34%). There was significant heterogeneity in effect sizes (Q-test χ(2) = 17.9, P < 0.004; I(2) = 72.1%). The type of diagnostic criteria used or study country did not significantly modify the effect. CONCLUSIONS These data provide evidence that in excess of one quarter of patients meeting accepted criteria for IBS-D have bile acid malabsorption. This distinction has implications for the interpretation of previous studies, as well as contemporaneous clinical practice and future guideline development.
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Affiliation(s)
- S A Slattery
- Neurogastroenterology Group, Blizard Institute of Cell & Molecular Science, Wingate Institute of Neurogastroenterology, Barts & the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - O Niaz
- Blackpool Victoria Hospital, Blackpool, UK
| | - Q Aziz
- Neurogastroenterology Group, Blizard Institute of Cell & Molecular Science, Wingate Institute of Neurogastroenterology, Barts & the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - A C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, Leeds University, Leeds, UK
| | - A D Farmer
- Neurogastroenterology Group, Blizard Institute of Cell & Molecular Science, Wingate Institute of Neurogastroenterology, Barts & the London School of Medicine & Dentistry, Queen Mary University of London, London, UK.,Department of Gastroenterology, University Hospitals of the North Midlands, Stoke on Trent, UK
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Miller V, Carruthers HR, Morris J, Hasan SS, Archbold S, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients. Aliment Pharmacol Ther 2015; 41:844-55. [PMID: 25736234 DOI: 10.1111/apt.13145] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 09/18/2014] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gut-focused hypnotherapy improves the symptoms of irritable bowel syndrome (IBS) with benefits being sustained for many years. Despite this, the technique has not been widely adopted by healthcare systems, possibly due to relatively small numbers in published studies and uncertainty about how it should be provided. AIM To review the effect of hypnotherapy in a large cohort of refractory IBS patients. METHODS One thousand IBS patients fulfilling Rome II criteria, mean age 51.6 years (range 17-91 years), 80% female, receiving 12 sessions of hypnotherapy over 3 months, were studied. The primary outcome was a 50 point reduction in the IBS Symptom Severity Score. The fall in scores for Noncolonic Symptoms, Quality of Life and Anxiety or Depression, were secondary outcomes. The Federal Drug Administration's recommended outcome of a 30% or more reduction in abdominal pain was also recorded. RESULTS Overall, 76% met the primary outcome which was higher in females (females: 80%, males: 62%, P < 0.001) and those with anxiety (anxious: 79%, non-anxious: 71%, P = 0.010). The mean reduction in other scores was: IBS Symptom Severity Score, 129 points (P < 0.001), Noncolonic Symptom Score, 65 (P < 0.001) and Quality of Life Score, 66 (P < 0.001). Sixty-seven per cent reported a 30% or more reduction in abdominal pain scores. Pain days fell from 18 to 9 per month. Patients with anxiety and depression fell from 63% to 34% and 25% to 12% respectively (P < 0.001). Outcome was unaffected by bowel habit subtype. CONCLUSION These results provide further evidence that gut-focused hypnotherapy is an effective intervention for refractory IBS.
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Affiliation(s)
- V Miller
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester, UK
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