The interaction between obesity and visceral hypersensitivity

Ebastine in combination with low-dose antidepressants for refractory irritable bowel syndrome: A randomized controlled trial

BackgroundDrug treatment of refractory irritable bowel syndrome (IBS) is not satisfactory at present. This study investigated the clinical effects of ebastine combined with low-dose antidepressants on refractory IBS.MethodsA total of 105 patients with refractory refractory IBS were randomly assigned to two different treatment groups after signing informed consent. And they didn't know about the treatment group they were in. They were administered with ebastine (Group A) or ebastine combined with flupentixol and melitracen (Group B) for 4 weeks. Drug efficacy was evaluated using scales before and after treatment. In addition, serum D-lactate (D-LAC) and human intestinal fatty acid binding protein (I-FABP) level were measured to assess intestinal permeability.ResultsSignificant improvements were observed in IBS Quality of Life (IBS-QOL) score, IBS Symptom Severity Scale (IBS-SSS) score, and total sleep quality score. Patients in Group A showed no improvements in anxiety (44.83 ± 9.62 vs. 43.92 ± 10.43, P = 0.415) and depression (39.08 ± 9.34 vs. 38.75 ± 9.35, P = 0.674) compared with the baseline level, while those in Group B improved significantly on anxiety (52.12 ± 8.19 vs. 39.28 ± 9.88) and depression (47.64 ± 9.53 vs. 38.24 ± 9.41) status. After treatment, the serum levels of D-LAC and I-FABP were significantly lower in Group B than in Group A.ConclusionRefractory IBS patients showed certain psychological abnormalities. Ebastine combined with antidepressants exhibited more obvious benefits on QOL, sleep quality, and SSS, with significant improvements in psychological status and intestinal permeability in refractory IBS patients.

Disorders of the gut-brain interaction among European people with obesity: Prevalence and burden of compatible symptoms

INTRODUCTION

The prevalence of disorders of the gut-brain interaction (DGBI) among people with obesity in the general population is unknown. Our aim was to assess the prevalence of DGBI among obese subjects in the general population in comparison with normal or overweight subjects, as well as exploring factors associated with DGBI in obesity in Europe.

METHODS

We included subjects who completed the internet-based survey of the Rome Foundation Global Epidemiology study in 11 European countries. Obesity was defined as a BMI>30 kg/m2 and participants were divided into three classes: 1: BMI 30 to <35 kg/m2, 2: BMI 35 to <40 kg/m2, and 3: BMI 40 kg/m2 or higher. The prevalence of symptoms compatible with DGBI was reported and compared between obese and normal or overweight (BMI between 18.5 and <30 kg/m2) participants. Factors potentially associated with DGBI and obesity including demographics, psychological distress (PHQ-4), non-GI somatic symptoms (PHQ-12), quality of life (PROMIS-10), healthcare access, medication and food consumption were assessed.

RESULTS

We included 20,117 participants in our analysis. The prevalence of obesity was 17.8% (95% CI 17.3, 18.4), with 12.6%, 3.7% and 1.6% in obesity classes 1, 2 and 3, respectively. The prevalence of any DGBI was 44.2% in the obese group versus 39.6% in the normal or overweight group (OR = 1.20 (1.12, 1.30)), with all DGBI being more prevalent in the obese versus normal or overweight group, with the exception for functional constipation where the opposite pattern was seen. Female sex, higher level of psychological distress and more severe non-GI somatic symptoms were seen in the group with DGBI associated with obesity.

CONCLUSIONS

Symptoms compatible with DGBI are common among European people with obesity in the general population and are linked with certain demographic and disease-related factors. This should be acknowledged in the management of patients with obesity.

Overweight and vitamin D deficiency are common in patients with irritable bowel syndrome - a cross-sectional study

BACKGROUND

Irritable bowel syndrome (IBS) is a common disease with unknown etiology. Poor dietary intake with nutritional deficiency and overweight have been described to increase the risk of IBS. The aim of the present study was to compare weight and circulating levels of micronutrients in IBS compared with healthy controls.

DESIGN

Cross-sectional study.

METHODS

Patients diagnosed with IBS and healthy volunteers were recruited. Participants had to complete a dietary diary book and the questionnaires Rome IV, IBS-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS). Weight and height were measured, and blood samples were drawn. C-reactive protein (CRP), cobalamin, folate, iron, total iron-binding capacity (TIBC), and 25-hydroxy (25-OH) vitamin D were analyzed. Differences were calculated between groups and generalized linear model for regressions was adjusted for false discovery rate (FDR).

RESULTS

IBS patients (n = 260) were elder than controls (n = 50) (44.00 (33.25-56.00) vs. 37.85 (30.18-45.48) years; p = 0.012). After adjustment for age, both weight (β: 5.880; 95% CI: 1.433-10.327; p = 0.010, FDR = 0.020) and body mass index (BMI) (β: 2.02; 95% CI: 0.68-3.36; p = 0.003, FDR = 0.012) were higher in patients. Among IBS participants, 48.1% were overweight/obese compared with 26.0% in controls (p = 0.007). Diarrhea-predominated IBS had highest weight (p < 0.001) and BMI (p = 0.077). CRP and cobalamin were higher in patients than controls (p = 0.010 vs. p = 0.007), whereas folate was highest in controls (p = 0.001). IBS patients had lower intake of vegetables (p = 0.026), dairy products (p = 0.004), and cereals (p = 0.010) compared with controls. Despite 21.5% of IBS patients were taking vitamin D supplements, 23.65% of them had vitamin D levels below 50 nmol/L, compared with 26.0% observed in the control group (p = 0.720). Vitamin D levels were lower in overweight than in normal weight IBS patients (60 (48-73) nmol/L vs. 65 (53-78) nmol/L, p = 0.022). Vitamin D correlated with cobalamin and folate but correlated inversely with TIBC and BMI. IBS patients had a high degree of gastrointestinal and extraintestinal symptoms, which were inversely associated with iron levels. Extraintestinal symptoms were associated with increased BMI.

CONCLUSION

IBS patients were often overweight or obese, with low vitamin D levels. High burden of extraintestinal symptoms were associated with overweight and lower iron levels.

REGISTRATION

ClinicalTrials.gov, NCT05192603 (Date of registration 11/29/2021) and NCT03306381 (Date of registration 09/18/2017), respectively.

Obesity Is Associated with Altered Rectal Sensitivity in Chronic Constipation

BACKGROUND

Defecation dysfunction may contribute to chronic constipation (CC), but the impact of obesity on anorectal physiology in CC remains unclear. We aimed to evaluate the relationship between obesity and anorectal function on physiologic testing in patients presenting with CC.

METHODS

This was a retrospective cohort study of consecutive adults who underwent high resolution anorectal manometry (HRAM) at a tertiary center for CC. Patient demographics, clinical history, surgical/obstetric history, medications, and HRAM results were reviewed. Patients were classified into obese (BMI > 30 kg/m2) vs non-obese (BMI < 30 kg/m2) groups at the time of HRAM. Fisher-exact/student t-test for univariate analyses and general linear regression for multivariable analysis were performed.

RESULTS

383 adults (mean 50.3 years; 85.8% female) with CC were included. On HRAM, patients with obesity had lower anal sphincter resting tone (37.3 vs 48.5 mmHg, p = 0.005) and maximum squeeze pressure (104.8 mmHg vs 120.0 mmHg, p = 0.043). No significant differences in dyssynergia (61% vs 53%, p = 0.294) and failed balloon expulsion (18% vs 25%, p = 0.381) were found between obese and non-obese groups. On balloon distention testing, the maximum tolerated (163.5 vs 147.6 mL, p = 0.042) and urge sensation (113.9 vs 103.7 mL, p = 0.048) volumes were significantly increased among patients with obesity. After adjusting for potential confounders, obesity remained independently associated with increased maximum tolerated volume (β-coefficient 13.7, p = 0.049).

CONCLUSION

Obesity was independently associated with altered rectal sensitivity among patients with CC. Altered rectal sensation may play an important role in CC among patients with obesity. Anorectal physiology testing should be considered to understand the pathophysiology and guide management.

The Role of Intestinal Barrier Function in Overweight Patients with IBS with Diarrhea Undergoing a Long-Term Low Fermentable Oligo-, Di-, and Monosaccharide and Polyol Diet

Overweight and obesity have been suggested as significant factors in irritable bowel syndrome (IBS) development. However, the relationship between overweight/obesity and IBS is unclear. It is known that a modified intestinal barrier, especially the permeability of the small intestine (s-IP), can play a significant role in the pathogenesis of both obesity and IBS. Moreover, dietary interventions are essential for treating both pathologies. We evaluated the gastrointestinal (GI) symptoms and the urinary and circulating markers of GI barrier function and integrity, the markers of intestinal dysbiosis and bacterial translocation, in 40 IBS patients with predominant diarrhea (IBS-D) (32 females and 8 males; mean age = 43.5 ± 1.4 years), categorized using their Body Mass Index levels as normal (NW) and overweight (OW). Evaluations were performed before and after 12 weeks of a Low FODMAP Diet (LFD). At the baseline, OW patients showed a significantly higher s-IP than NW. After an LFD, a significant improvement of s-IP in OW patients occurred, along with a significant decrease in markers of epithelial integrity and bacterial translocation. Our findings highlight the close relationship between overweight and the intestinal barrier and support their involvement in IBS-D pathophysiology. Furthermore, the positive role of an LFD in managing overweight IBS-D was highlighted.