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Lomer MCE. The low FODMAP diet in clinical practice: where are we and what are the long-term considerations? Proc Nutr Soc 2024; 83:17-27. [PMID: 37415490 DOI: 10.1017/s0029665123003579] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) improves functional bowel symptoms and is a second-line dietary management strategy for the treatment of irritable bowel syndrome (IBS). The diet is complex and involves three stages: restriction, reintroduction and personalisation and clinical effectiveness is achieved with dietitian-led education; however, this is not always available. The aim of this review is to provide an update on the evidence for using the low FODMAP diet, with a focus on the impact of FODMAP restriction and reintroduction considering long-term management of IBS in a clinical setting. Randomised controlled trials have assessed symptom response, quality of life, dietary intake and changes to the gut microbiota during FODMAP restriction. Systematic reviews and meta-analyses consistently report that FODMAP restriction has a better symptom response compared with control diets and a network analysis reports the low FODMAP diet is superior to other dietary treatments for IBS. Research focused on FODMAP reintroduction and personalisation is limited and of lower quality, however common dietary triggers include wheat, onion, garlic, pulses and milk. Dietitian-led delivery of the low FODMAP diet is not always available and alternative education delivery methods, e.g. webinars, apps and leaflets, are available but remove the personalised approach and may be less acceptable to patients and may introduce safety concerns in terms of nutritional adequacy. Predicting response to the low FODMAP diet using symptom severity or a biomarker is of great interest. More evidence on less restrictive approaches and non-dietitian-led education delivery methods are needed.
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Affiliation(s)
- Miranda C E Lomer
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
- Department of Nutritional Sciences, King's College London, Stamford Street, London, UK
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2
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Belogianni K, Seed PT, Lomer MCE. Development and validation of a knowledge, attitudes and practices questionnaire in the dietary management of irritable bowel syndrome. Eur J Clin Nutr 2023; 77:911-918. [PMID: 37438464 PMCID: PMC10473958 DOI: 10.1038/s41430-023-01306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To develop and validate a questionnaire assessing knowledge, attitudes and practices in the dietary management of IBS. SUBJECTS/METHODS An initial pool of 151 questions was generated addressing three domains (knowledge, attitudes, practices). Academic/senior clinical dietitians (n = 5) provided written feedback and a focus group (n = 4 gastroenterology dietitians) was undertaken to evaluate content and face validity of the question-items. Items considered irrelevant were removed and the refined questionnaire was administered to dietitians with different levels of IBS experience (n = 154) for further psychometric testing. Item reduction analysis was assessed by item difficulty index, discrimination index and point-biserial correlation. Construct validity was assessed via principal component analysis (PCA) and the 'known-groups' method. Internal reliability was assessed by Kuder-Richarson Formula 20 and Cronbach's alpha coefficient and external reliability by interclass correlation coefficient among participants who completed the instrument at baseline and two weeks later (n = 28). RESULTS Face and content validity resulted in the removal of 61 items from the initial 151 items. Psychometric testing was applied to the refined 90-item questionnaire administered to participating dietitians, resulting in the final 46-item questionnaire. Six factors were extracted by PCA with varimax rotation explaining 59.2% of the total variance. Partial confirmatory factor analysis showed an acceptable model fit (χ2/df = 2.11, CFI = 0.97, TLI = 0.96, RMSEA = 0.08, SRMR = 0.05). Significant differences were found in sum scores among dietitians with different levels of IBS experience. Internal reliability was >0.7 for each factor. External reliability was >0.6 for each factor and >0.7 for overall items of each domain. CONCLUSION A validated questionnaire to use in practice and research to assess knowledge, attitudes and practices in the dietary management of IBS has been developed.
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Affiliation(s)
- Katerina Belogianni
- Faculty of Life Sciences and Medicine, Nutritional Sciences, King's College London, 150 Stamford Street, London, SE1 9NH, UK.
| | - Paul Townsend Seed
- Faculty of Life Course and Population Sciences, Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Miranda Clare Elizabeth Lomer
- Faculty of Life Sciences and Medicine, Nutritional Sciences, King's College London, 150 Stamford Street, London, SE1 9NH, UK
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
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Agwa RH, Alharthi Z, Alzahrani AT, Alghamdi MA, Alzahrani RA, Alghamdi AA, Alghamdi RH, Alghamdi SR, Alghamdi AA. The Prevalence of Irritable Bowel Syndrome and Its Co-existence With Migraine in Medical and Non-medical Students at Al-Baha University, Saudi Arabia. Cureus 2023; 15:e44077. [PMID: 37750120 PMCID: PMC10518046 DOI: 10.7759/cureus.44077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND It was hypothesized that the prevalence of irritable bowel syndrome (IBS) and migraine and their co-existence are higher among medical students. In this study, we aim to establish the prevalence of IBS and migraine in the medical and non-medical students at Al-Baha University, Saudi Arabia, and to observe the association and relationship between IBS and migraine using the Rome IV diagnostic criteria for IBS and the International Classification of Headache Disorders (ICHD)-3 criteria for migraine. METHODOLOGY This cross-sectional study was done on the Saudi Arabian campus of Al-Baha University between July 2022 and July 2023. Al-Baha city-dwelling male and female college students aged 18 to 29 comprised the study population. A self-administered electronic questionnaire was sent online to determine the prevalence of IBS and migraine, in addition to associated risk factors. The questionnaire consisted of three sections: demographic and lifestyle data, the Rome IV criteria for diagnosing and subclassifying IBS, and the ICHD-3 criteria for diagnosing migraine. RESULTS The study was conducted among 452 participants with a mean age of 21.64 years. The majority of participants were not from medical schools. The majority of medical and non-medical participants were male, at 66.6% and 63.1%, respectively. In our study, 36.9% of the individuals reported having a first-degree relative diagnosed with IBS, whereas 2.7% reported having IBS themselves. Regarding migraine, 17.9% of respondents claimed to have a first-degree relative with migraine, while 6.9% of respondents themselves reported experiencing migraine. Regarding IBS prevalence, there was no significant difference between participants from non-MBBS colleges and MBBS colleges. Similarly, there was no significant difference in migraine prevalence between these two groups (92.0% vs. 95.4%, p=0.185). CONCLUSION The current study contributes significantly to our understanding of the prevalence of IBS and migraines among medical students, as well as these individuals' demographic characteristics, familial histories, and aggravating variables.
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Affiliation(s)
- Ramy H Agwa
- Internal Medicine, Hepatology and Gastroenterology, Mansoura University, Mansoura, EGY
- Internal Medicine, Hepatology and Gastroenterology, Al-Baha University, Al-Baha, SAU
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Alghamdi AA, Alghamdi AM, Alshareef MA, AlGhamdi AA, Alghamdi RA, AlAmri AA, Alzahrani GT. Assessment of Sleep Quality Among Adolescents and Adults With Self-Diagnosed Irritable Bowel Syndrome, in Jeddah, Saudi Arabia. Cureus 2023; 15:e42778. [PMID: 37663979 PMCID: PMC10469519 DOI: 10.7759/cureus.42778] [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: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background The frequency of irritable bowel syndrome (IBS) has increased significantly in the last ten years. Few studies were done in Saudi Arabia to assess the relationship between sleep quality and IBS. This study aims to assess the prevalence of IBS and its association with sleep quality among adolescents and adults in Saudi Arabia. Methods A cross-sectional study was done on 651 participants aged 15-65 years. An online questionnaire was used to collect data, including demographics; the Rome IV criteria (R4DQ) was used in the diagnosis of IBS, the IBS symptoms severity scale (IBS-SSS) assessed IBS symptoms and severity, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Results Based on the Rome IV criteria, 25.7% of the participants had IBS. Among them, 23.3%, 17.9%, 47.3%, and 11.5% had IBS types constipation (C), diarrhea (D), mixed bowel habits (M), and undefined subtype (U), respectively. Mild, moderate, and severe IBS were found among 43.1%, 39.5%, and 17.4% of IBS cases, respectively. About 46% had poor sleep quality, which was significantly higher among those with younger mean age, females, and students. Patients with IBS exhibited a considerably greater prevalence of poor sleep quality, and IBS-C had the highest prevalence. Conclusion A correlation was found between poor sleep quality and the positive status of IBS diagnosis among adolescents and adults. An evaluation of specific sleep disorders among IBS patients is needed.
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Sua T, Montoya C, Luo D, Rostami K. Is Irritable Bowel Syndrome out of date and misleading as a diagnosis? GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2023; 16:210-216. [PMID: 37554743 PMCID: PMC10404840 DOI: 10.22037/ghfbb.v16i2.2761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/02/2023] [Indexed: 08/10/2023]
Abstract
Aim This study aimed at assessing the efficacy of targeted interventions addressing common food sensitivities and lifestyle factors that commonly contribute to the presentation of gastrointestinal problems identified as Irritable bowel syndrome (IBS). Background IBS has served to cover the expression of multifactorial disorders with variable aetiology and pathophysiology. Food antigens implicated in the modern lifestyle, acting as strong epigenetic factors is strongly implicated in pathophysiology of conditions under IBS. Identifying and addressing food sensitivities in patients presenting with IBS like symptoms are currently underemphasised in clinical guidelines yet have the potential to provide major benefits for patients. Methods Information was collected from the medical records of patients that were referred to the Gastroenterology Unit of Palmerston North DHB with unexplained gastrointestinal (GI) symptoms with or without other GI comorbidities between September 2018 and November 2021. Results The main management option offered to the 121 patients included in this study, was lifestyle adjustment and/or a trial of 6 weeks, eliminating gluten and lactose from the diet. The most prevalent symptoms were abdominal pain 96/121 (79%), diarrhoea 83/121 (69%), followed by bloating and constipation. Seventy-eight patients had the outcomes of their improvement available. A total of 42 out of 78 patients (54%) were treated exclusively with gluten and lactose-free diet, in this group of patients 86% (36/42) reported a significant improvement in their symptoms with a score in the range of 40-100%. Conclusion Our study illustrates the importance of focusing on triggering factors when assessing patients with IBS. We suggest that careful identifying and eliminating the triggering food antigens as monotherapy or in addition to the lifestyle adjustment where appropriate should be the main objective in symptomatic patients fulfilling the IBS diagnostic criteria. These combinations and holistic approach in treating IBS' patients' symptoms are less expensive, non-toxic, and highly effective in achieving optimal outcomes and improving these patient's quality of life.
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Affiliation(s)
- Taliah Sua
- University of Otago, Wellington, New Zealand
| | - Carlos Montoya
- AgResearch, Massey University, Palmerston North, New Zealand
| | | | - Kamran Rostami
- Department of Gastroenterology, MidCentral DHB, Palmerston North Hospital, Palmerston North, New Zealand
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Goodoory VC, Ng CE, Black CJ, Ford AC. Direct healthcare costs of Rome IV or Rome III-defined irritable bowel syndrome in the United Kingdom. Aliment Pharmacol Ther 2022; 56:110-120. [PMID: 35491477 PMCID: PMC9325446 DOI: 10.1111/apt.16939] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/28/2022] [Accepted: 04/08/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies have demonstrated a substantial economic impact of irritable bowel syndrome (IBS). AIMS To provide contemporaneous estimates of direct healthcare costs of IBS in the United Kingdom. METHODS We collected demographic, gastrointestinal and psychological symptoms, quality of life and healthcare usage data from adults with Rome IV or Rome III IBS in the United Kingdom. We calculated the mean annual direct healthcare costs of IBS per person and used contemporaneous IBS prevalence data, together with census data, to estimate annual direct costs of IBS. We also examined predictors of higher costs. RESULTS The mean annual direct cost of IBS per person among 752 individuals with Rome IV IBS was £556.65 (SD £1023.92) and £474.16 (SD £897.86) for 995 individuals with Rome III IBS. We estimate the annual direct healthcare cost of IBS in the United Kingdom is £1.27 billion if the Rome IV criteria are used to define IBS, and £2.07 billion using Rome III. Among individuals with Rome IV IBS, mean annual costs were higher in those with opiate use (£907.90 vs £470.58, p < 0.001), more severe symptoms (p < 0.001 for trend), a shorter duration of IBS (1 year, £1227.14 vs >5 years £501.60, p = 0.002), lower quality of life (p < 0.001 for trend), and higher depression, somatisation and gastrointestinal symptom-specific anxiety scores (P < 0.001 for trend for all). CONCLUSION We estimate annual direct healthcare costs of IBS of between £1.3 and £2 billion in the United Kingdom.
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Affiliation(s)
- Vivek C. Goodoory
- Leeds Institute of Medical Research at St. James’sUniversity of LeedsLeedsUK,Leeds Gastroenterology InstituteSt. James’s University HospitalLeedsUK
| | - Cho Ee Ng
- County Durham and Darlington NHS Foundation TrustDurhamUK
| | - Christopher J. Black
- Leeds Institute of Medical Research at St. James’sUniversity of LeedsLeedsUK,Leeds Gastroenterology InstituteSt. James’s University HospitalLeedsUK
| | - Alexander C. Ford
- Leeds Institute of Medical Research at St. James’sUniversity of LeedsLeedsUK,Leeds Gastroenterology InstituteSt. James’s University HospitalLeedsUK
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Lambarth A, Zarate-Lopez N, Fayaz A. Oral and parenteral anti-neuropathic agents for the management of pain and discomfort in irritable bowel syndrome: A systematic review and meta-analysis. Neurogastroenterol Motil 2022; 34:e14289. [PMID: 34755926 DOI: 10.1111/nmo.14289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a highly prevalent and economically burdensome condition; and pain is often the most unpleasant, disruptive, and difficult-to-treat symptom. Visceral hypersensitivity is a common feature driving pain in IBS, suggesting that neuropathic mechanisms may be implicated. We conducted a systematic review of available evidence to examine the role of anti-neuropathic medicines in the management of pain in IBS. METHODS We systematically searched scientific repositories for trials investigating conventional oral, and/or parenteral, pharmaceutical antineuropathic treatments in patients with IBS. We summarized key participant characteristics, outcomes related to pain (primary outcome), and selected secondary outcomes. KEY RESULTS We included 13 studies (n = 629 participants): six investigated amitriptyline, three duloxetine, three pregabalin, and one gabapentin. There was considerable methodological and statistical heterogeneity, so we performed a narrative synthesis and limited meta-analysis. Amitriptyline was most extensively studied, though only in diarrhea-predominant patients. In individual trials, amitriptyline, pregabalin and gabapentin generally appeared beneficial for pain outcomes. While duloxetine studies tended to report improvements in pain, all were un-controlled trials with high risk of bias. Meta-analysis of three studies (n = 278) yielded a pooled relative-risk of 0.50 (95%CI 0.38-0.66) for not improving with anti-neuropathic agent vs control. We did not identify any eligible studies investigating the role of parenteral anti-neuropathics. CONCLUSIONS AND INFERENCES Anti-neuropathic analgesics may improve pain in IBS, and deserve further, high-quality investigation, potentially considering parenteral administration and agents with minimal gastrointestinal motility effects. Investigation of amitriptyline's efficacy in non-diarrhea-predominant subtypes is currently lacking, and we recommend particular caution for its use in IBS-C.
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Affiliation(s)
- Andrew Lambarth
- University College London Hospitals NHS Foundation Trust, Pain Education Research Centre, University College Hospitals NHS Foundation Trust: PERC@UCLH, London, UK
| | - Natalia Zarate-Lopez
- University College London Hospital Gastrointestinal Physiology Unit, Pain Education Research Centre, University College Hospitals NHS Foundation Trust: PERC@UCLH, London, UK
| | - Alan Fayaz
- University College Hospitals NHS Foundation Trust, Pain Education Research Centre, University College Hospitals NHS Foundation Trust: PERC@UCLH, London, UK
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Gillan C. Review article: the effectiveness of group and self-help hypnotherapy for irritable bowel syndrome and the implications for improving patients' choice and access to treatment. Aliment Pharmacol Ther 2021; 54:1389-1404. [PMID: 34591988 DOI: 10.1111/apt.16623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/04/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Individual hypnotherapy (IH) is a recognised treatment for irritable bowel syndrome (IBS). However, it is not widely available to patients due to its resource-intensive nature, lack of adequately trained therapists, and scepticism about hypnosis. Non-individualised hypnotherapy approaches, such as group and self-help hypnotherapy, could maximise existing therapist resources by treating more patients at the same time, thus widening patient access to treatment without incurring additional expenditure. AIMS To investigate the research literature for non-individualised approaches to hypnotherapy for IBS and to determine their effectiveness for reducing symptom severity and/or providing adequate relief. METHODS A literature review of published peer-reviewed studies was conducted. Quantitative research was selected to determine the effectiveness of the interventions. RESULTS Ten studies were eligible for inclusion. Three delivered group hypnotherapy, three integrated hypnosis within a group concept, and four utilised a self-help home hypnotherapy treatment using audio recordings. Both group hypnotherapy for adults and the self-help home hypnotherapy treatment for children were effective interventions that may be non-inferior to IH for patients with mild-to-moderate symptoms. Treatment benefits were long-lasting. The evidence for the integrative group concept and home treatment for adults was less compelling. CONCLUSIONS Group hypnotherapy for adults, and self-help hypnotherapy for children, may be cost-effective treatments that can widen access for patients with milder IBS in primary care settings. Further research is needed to determine the effectiveness of group hypnotherapy for patients with severe, refractory IBS.
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Affiliation(s)
- Carolyn Gillan
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
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Choudhary A, Fikree A, Aziz Q. Overlap between irritable bowel syndrome and hypermobile Ehlers-Danlos syndrome: An unexplored clinical phenotype? AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2021; 187:561-569. [PMID: 34741491 DOI: 10.1002/ajmg.c.31938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022]
Abstract
Irritable bowel syndrome (IBS) is common, but its cause remains unknown. IBS patients present with gastrointestinal (GI) symptoms such as abdominal pain with altered bowel habits; however, some patients also have non-GI symptoms including muscle and joint pains. It is thus plausible that within large IBS cohorts, subgroups exist with distinct clinical phenotypes. Yet, these subgroups have not been clearly identified or characterized. Due to lack of segmentation, treatment-focused symptomatic management is similar for all with IBS and follows indiscriminate algorithms regardless of possible differing clinical phenotype. This universal approach to IBS management may account for the reported lack of efficacy of treatment. One emerging subgroup receiving increasing attention is that with overlap IBS and the underlying heritable connective tissue disorder, hypermobile Ehlers-Danlos syndrome (hEDS). Current evidence suggests that up to 62% of patients with hEDS suffer from IBS. However, despite recognition of the presence of IBS in hEDS, this overlap IBS/hEDS group has not been characterized and these patients are managed in a similar way to those with IBS alone. Future studies are required to characterize and deep phenotype in this overlap IBS/hEDS group.
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Affiliation(s)
- Anisa Choudhary
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Asma Fikree
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Qasim Aziz
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Eijsbouts C, Zheng T, Kennedy NA, Bonfiglio F, Anderson CA, Moutsianas L, Holliday J, Shi J, Shringarpure S, Voda AI, Farrugia G, Franke A, Hübenthal M, Abecasis G, Zawistowski M, Skogholt AH, Ness-Jensen E, Hveem K, Esko T, Teder-Laving M, Zhernakova A, Camilleri M, Boeckxstaens G, Whorwell PJ, Spiller R, McVean G, D'Amato M, Jostins L, Parkes M. Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders. Nat Genet 2021; 53:1543-1552. [PMID: 34741163 PMCID: PMC8571093 DOI: 10.1038/s41588-021-00950-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 09/08/2021] [Indexed: 12/19/2022]
Abstract
Irritable bowel syndrome (IBS) results from disordered brain-gut interactions. Identifying susceptibility genes could highlight the underlying pathophysiological mechanisms. We designed a digestive health questionnaire for UK Biobank and combined identified cases with IBS with independent cohorts. We conducted a genome-wide association study with 53,400 cases and 433,201 controls and replicated significant associations in a 23andMe panel (205,252 cases and 1,384,055 controls). Our study identified and confirmed six genetic susceptibility loci for IBS. Implicated genes included NCAM1, CADM2, PHF2/FAM120A, DOCK9, CKAP2/TPTE2P3 and BAG6. The first four are associated with mood and anxiety disorders, expressed in the nervous system, or both. Mirroring this, we also found strong genome-wide correlation between the risk of IBS and anxiety, neuroticism and depression (rg > 0.5). Additional analyses suggested this arises due to shared pathogenic pathways rather than, for example, anxiety causing abdominal symptoms. Implicated mechanisms require further exploration to help understand the altered brain-gut interactions underlying IBS.
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Affiliation(s)
- Chris Eijsbouts
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Tenghao Zheng
- Center for Molecular Medicine & Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Nicholas A Kennedy
- IBD Pharmacogenetics, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ferdinando Bonfiglio
- Center for Molecular Medicine & Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Carl A Anderson
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Loukas Moutsianas
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Joanne Holliday
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Alexandru-Ioan Voda
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Saint Edmund Hall, University of Oxford, Oxford, UK
| | - Gianrico Farrugia
- Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Matthias Hübenthal
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Department of Dermatology, Quincke Research Center, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Gonçalo Abecasis
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Matthew Zawistowski
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Anne Heidi Skogholt
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eivind Ness-Jensen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kristian Hveem
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tõnu Esko
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Maris Teder-Laving
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Alexandra Zhernakova
- Department of Genetics, University Medical Center Groningen, Groningen, the Netherlands
| | - Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Guy Boeckxstaens
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Peter J Whorwell
- Neurogastroenterology Unit, Wythenshawe Hospital, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK
| | - Robin Spiller
- Nottingham Digestive Diseases Centre, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Gil McVean
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Mauro D'Amato
- Center for Molecular Medicine & Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia.
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany.
- Biodonostia Health Research Institute, San Sebastian, Spain.
- Gastrointestinal Genetics Lab, CIC bioGUNE - Basque Research and Technology Alliance, Derio, Spain.
- IKERBASQUE, The Basque Science Foundation, Bilbao, Spain.
| | - Luke Jostins
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK.
- Christ Church, University of Oxford, Oxford, UK.
| | - Miles Parkes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Cambridge, Cambridge, UK.
- Department of Gastroenterology, Cambridge University Hospital, Cambridge, UK.
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Vitamin D supplementation in people with IBS has no effect on symptom severity and quality of life: results of a randomised controlled trial. Eur J Nutr 2021; 61:299-308. [PMID: 34328539 PMCID: PMC8783891 DOI: 10.1007/s00394-021-02633-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/28/2021] [Indexed: 02/08/2023]
Abstract
Purpose Several small trials suggest a benefit of vitamin D supplementation in irritable bowel syndrome (IBS). The generalisability of these reports is limited by their design and scale. This study aimed to assess whether vitamin D supplementation improved IBS symptoms in a UK community setting. Methods This was a randomised, double-blind, placebo-controlled study. Participants were recruited from the community in winter months between December 2017 and March 2019. 135 participants received either vitamin D (3,000 IU p.d.) or placebo for 12 weeks. The primary outcome measure was change in IBS symptom severity; secondary outcomes included change in IBS-related quality of life. Results The participants were analysed on an intent-to-treat basis. 60% of participants were vitamin D deficient or insufficient at baseline. Although vitamin D levels increased in the intervention arm relative to placebo (45.1 ± 32.88 nmol/L vs 3.1 ± 26.15 nmol/L; p < 0.001). There was no difference in the change of IBS symptom severity between the active and placebo trial arms (− 62.5 ± 91.57 vs – 75.2 ± 84.35, p = 0.426) over time. Similarly there was no difference between trial arms in τhe change in quality of life (− 7.7 ± 25.36 vs – 11.31 ± 25.02, p = 0.427). Conclusions There is no case for advocating use of vitamin D in the management of IBS symptoms. The prevalence of vitamin D insufficiency suggests routine screening and supplementation should be implemented in this population for general health reasons. This trial was retrospectively registered with ISRCTN (ISRCTN13277340) on 24th April 2018 after recruiting had been initiated. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-021-02633-w.
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12
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Tetrodotoxin: A New Strategy to Treat Visceral Pain? Toxins (Basel) 2021; 13:toxins13070496. [PMID: 34357968 PMCID: PMC8310099 DOI: 10.3390/toxins13070496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
Visceral pain is one of the most common symptoms associated with functional gastrointestinal (GI) disorders. Although the origin of these symptoms has not been clearly defined, the implication of both the central and peripheral nervous systems in visceral hypersensitivity is well established. The role of several pathways in visceral nociception has been explored, as well as the influence of specific receptors on afferent neurons, such as voltage-gated sodium channels (VGSCs). VGSCs initiate action potentials and dysfunction of these channels has recently been associated with painful GI conditions. Current treatments for visceral pain generally involve opioid based drugs, which are associated with important side-effects and a loss of effectiveness or tolerance. Hence, efforts have been intensified to find new, more effective and longer-lasting therapies. The implication of VGSCs in visceral hypersensitivity has drawn attention to tetrodotoxin (TTX), a relatively selective sodium channel blocker, as a possible and promising molecule to treat visceral pain and related diseases. As such, here we will review the latest information regarding this toxin that is relevant to the treatment of visceral pain and the possible advantages that it may offer relative to other treatments, alone or in combination.
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13
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Wallén H, Lindfors P, Andersson E, Hedman-Lagerlöf E, Hesser H, Lindefors N, Svanborg C, Ljótsson B. Return on investment of internet delivered exposure therapy for irritable bowel syndrome: a randomized controlled trial. BMC Gastroenterol 2021; 21:289. [PMID: 34256715 PMCID: PMC8276403 DOI: 10.1186/s12876-021-01867-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/21/2021] [Indexed: 12/31/2022] Open
Abstract
Background Irritable bowel syndrome (IBS) is a debilitating and costly disorder. Cognitive behavior therapy (CBT) is effective in the treatment of IBS, both when delivered over the internet and in face-to-face settings. CBT consists of different components and little is known about their relative importance. We have in an earlier study showed that inclusion of exposure in the CBT for IBS makes it even more effective. In the present study we wanted to evaluate the economic effects for society of inclusion vs exclusion of exposure in an internet delivered CBT for IBS. Methods We used data from a previous study with 309 participants with IBS. Participants were randomized to internet delivered CBT with (ICBT) or without exposure (ICBT-WE). We compared direct and indirect costs at baseline, after treatment, and 6 months after treatment (primary endpoint; 6MFU). Data was also collected on symptom severity and time spent by therapists and participants. The relative Incremental Cost Effectiveness Ratio (ICER) was calculated for the two treatment conditions and the return on investment (ROI). Results Results showed that ICBT cost $213.5 (20%) more than ICBT-WE per participant. However, ICBT was associated with larger reductions regarding both costs and symptoms than ICBT-WE at 6MFU. The ICER was − 301.69, meaning that for every point improvement on the Gastrointestinal Symptom Rating Scale—IBS version in ICBT, societal costs would be reduced with approximately $300. At a willingness to pay for a case of clinically significant improvement in IBS symptoms of $0, there was an 84% probability of cost-effectiveness. ROI analysis showed that for every $1 invested in ICBT rather than ICBT-WE, the return would be $5.64 six months after treatment. Analyses of post-treatment data showed a similar pattern although cost-savings were smaller. Conclusions Including exposure in Cognitive Behavior Treatment for IBS is more cost-effective from a societal perspective than not including it, even though it may demand more therapist and patient time in the short term. Trial registration This study is reported in accordance with the CONSORT statement for non-pharmacological trials [1]. Clinicaltrials.gov registration ID: NCT01529567 (14/02/2013).
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Affiliation(s)
- Hugo Wallén
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden.
| | - Perjohan Lindfors
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden
| | - Hugo Hesser
- School of Law, Psychology and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, 141 86, Stockholm, Sweden
| | - Cecilia Svanborg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, 141 86, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden
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14
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Vasant DH, Paine PA, Black CJ, Houghton LA, Everitt HA, Corsetti M, Agrawal A, Aziz I, Farmer AD, Eugenicos MP, Moss-Morris R, Yiannakou Y, Ford AC. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70:1214-1240. [PMID: 33903147 DOI: 10.1136/gutjnl-2021-324598] [Citation(s) in RCA: 183] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022]
Abstract
Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new evidence published concerning the diagnosis, investigation and management of IBS. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients. One of the strengths of this guideline is that the recommendations for treatment are based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of trial-based and network meta-analyses assessing the efficacy of dietary, pharmacological and psychological therapies in treating IBS. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence. Finally, this guideline identifies novel treatments that are in development, as well as highlighting areas of unmet need for future research.
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Affiliation(s)
- Dipesh H Vasant
- Neurogastroenterology Unit, Gastroenterology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Peter A Paine
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK.,Gastroenterology, Salford Royal Foundation Trust, Salford, UK
| | - Christopher J Black
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Lesley A Houghton
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Hazel A Everitt
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Maura Corsetti
- Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, UK
| | - Anurag Agrawal
- Gastroenterology, Doncaster and Bassetlaw Hospitals NHS Trust, Armthorpe Road, Doncaster, UK
| | - Imran Aziz
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Adam D Farmer
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,School of Medicine, Keele University, Keele, UK
| | - Maria P Eugenicos
- Department of Gastroenterology, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Rona Moss-Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yan Yiannakou
- Department of Gastroenterology, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK .,Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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15
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Rostami K, Bold J, Ismail Ali J, Parr A, Dieterich W, Zopf Y, Htoo A, Rostami-Nejad M, Danciu M. An algorithm for differentiating food antigen-related gastrointestinal symptoms. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2021; 14:8-16. [PMID: 33868604 PMCID: PMC8035543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/22/2020] [Indexed: 11/03/2022]
Abstract
AIM The aim of this clinical audit was to assess patient-reported outcomes on the effect of dietary intervention, to enhance our understanding of possible treatment options in irritable bowel syndrome (IBS). BACKGROUND A large number of food-related gastro-intestinal disorders have been attributed to IBS for decades. METHODS Patient-reported outcomes from the records of 149 IBS patients treated at secondary and tertiary Gastroenterology outpatients in two UK hospitals between January 2014 and July 2016 were audited. Patients all presented with symptoms fulfilling Rome III-IV criteria for IBS had negative coeliac serology and did not have other gastrointestinal (GI) conditions. A modified version of a low FODMAP diet had been recommended (gluten and lactose free diet (G/LFD)) and was implemented for 6 weeks. Outcomes and dietary adherence were recorded during outpatient's consultations. RESULTS A total of 134 patients complied with the diet optimally. The majority had an improvement rate >70% and continued with the diet. Fifty-three percent became completely or almost asymptomatic, while 27.6% had a poor response to the diet (scoring < 30%) to G/LFD. The improvement was excellent in patients with normal BMI and good in overweight and obese and where BMI <18. Over 50% did not require any follow-up within 12 months. CONCLUSION Although it is unclear whether symptoms are triggered by gluten, fructans or lactose, elimination of gluten and lactose proved to be an effective treatment in patients with IBS. Multidisciplinary team management and implementation of detailed nutrition therapy using the audit algorithm might prove to be both cost effective and efficacious a treatment option in IBS.
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Affiliation(s)
- Kamran Rostami
- Department of Gastroenterology, MidCentral DHB, Palmerston North, New Zealand
- Department of Gastroenterology, Milton Keynes University Hospital NHS Trust, UK
| | - Justine Bold
- The School of Allied Health and Community, University of Worcester, Worcester, UK
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff UK
| | - Jafer Ismail Ali
- Department of Gastroenterology, Milton Keynes University Hospital NHS Trust, UK
| | | | - Walburga Dieterich
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Hector Centre of Excellence for Nutrition, Exercise and Sports, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Yurdagül Zopf
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Hector Centre of Excellence for Nutrition, Exercise and Sports, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Aung Htoo
- Department of Gastroenterology, MidCentral DHB, Palmerston North, New Zealand
| | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center,Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihai Danciu
- Grigore T Popa” University of Medicine and Pharmacy, Iasi, Romania
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16
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Williams M, Barclay Y, Harper L, Marchant C, Seamark L, Hickson M. Feasibility, acceptability and cost efficiency of using webinars to deliver first‐line patient education for people with Irritable Bowel Syndrome as part of a dietetic‐led gastroenterology service in primary care. J Hum Nutr Diet 2020; 33:758-766. [DOI: 10.1111/jhn.12799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Affiliation(s)
- M. Williams
- Community Dietetics Service Somerset NHS Foundation Trust Taunton UK
| | - Y. Barclay
- Community Dietetics Service Somerset NHS Foundation Trust Taunton UK
| | - L. Harper
- Community Dietetics Service Somerset NHS Foundation Trust Taunton UK
| | - C. Marchant
- Community Dietetics Service Somerset NHS Foundation Trust Taunton UK
| | - L. Seamark
- Community Dietetics Service Somerset NHS Foundation Trust Taunton UK
| | - M. Hickson
- Institute of Health and Community University of Plymouth Plymouth UK
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17
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Bowers H, Gillanders D, Ferreira N. Moderating effect of IBS acceptance on psychosocial mediators of Irritable Bowel Syndrome. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Gastrointestinal disorders-induced pain. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2019.100580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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A 5Ad Dietary Protocol for Functional Bowel Disorders. Nutrients 2019; 11:nu11081938. [PMID: 31426496 PMCID: PMC6722668 DOI: 10.3390/nu11081938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 02/06/2023] Open
Abstract
Functional bowel disorders (FBDs) affect around 20% of the population worldwide and are associated with reduced quality of life and high healthcare costs. Dietary therapies are frequently implemented to assist with symptom relief in these individuals, however, there are concerns regarding their complexity, restrictiveness, nutritional adequacy, and effectiveness. Thus, to overcome these limitations, a novel approach, the 5Ad Dietary Protocol, was designed and tested for its efficacy in reducing the severity of a range of gastrointestinal symptoms in 22 subjects with FBDs. The protocol was evaluated in a repeated measures MANOVA design (baseline week and intervention week). Measures of stool consistency and frequency were subtyped based on the subject baseline status. Significant improvements were seen in all abdominal symptom measures (p < 0.01). The effect was independent of body mass index (BMI), age, gender, physical activity level, and whether or not the subjects were formally diagnosed with irritable bowel syndrome (IBS) prior to participation. Stool consistency and frequency also improved in the respective contrasting subtypes. The 5Ad Dietary Protocol proved to be a promising universal approach for varying forms and severities of FBDs. The present study paves the way for future research encompassing a longer study duration and the exploration of underlying physiological mechanisms.
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20
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How do people with refractory irritable bowel syndrome perceive hypnotherapy: Qualitative study protocol. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Fernandes DCR, Poon D, White LL, Andreyev HJN. What is the cost of delayed diagnosis of bile acid malabsorption and bile acid diarrhoea? Frontline Gastroenterol 2019; 10:72-76. [PMID: 30651961 PMCID: PMC6319159 DOI: 10.1136/flgastro-2018-101011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/20/2018] [Accepted: 07/09/2018] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION 75Selenium taurocholic acid (SeHCAT) scanning diagnoses bile acid malabsorption/bile acid diarrhoea (BAM/BAD) and defines optimal treatment. Approximately 2% of the population have BAM/BAD. AIM To evaluate the cost of delayed diagnosis of BAM/BAD. METHODS Patients' notes who underwent SeHCAT scanning in three hospitals over a 1-year period were reviewed retrospectively. Scan results and treatment response were recorded. Package-of-care costs were calculated using costing tools from the National Institute for Health and Care Excellence and from United Lincolnshire Hospitals Trust business unit. RESULTS Between June 2016 and May 2017, 19 men and 37 women (median age 58 (range 19-83)) of 3860 new patients seen in gastroenterology clinics were referred for SeHCAT scanning. Sixty-four per cent of scans were abnormal: 13 demonstrated severe (<5% 7-day SeHCAT retention), 13 moderate (5%-10%), 5 mild (10%-15%) and 5 borderline (15%-20%) BAD/BAM. Likely causes included primary BAD (n=16), cholecystectomy (n=13), inflammatory bowel disease (n=4) and other (n=3). If SeHCAT scanning was ordered at first consultation (n=11), patients reported 24 months (median) of symptoms (range 6-360) and the median diagnostic package-of-care cost was £811.40 (95% CI £625.59 to £1508.20). If SeHCAT scanning was booked later (n=25), patients reported symptoms for 30 months (median, range 0.5-360) and the cost was £1568.31 (95% CI £1200.55 to £1713.18). Following diagnosis, treatment led to symptom improvement (n=24), no change/deterioration (n=3) and not reported (n=9). CONCLUSIONS SeHCAT is underused. Late diagnosis leads to unnecessary demands for other services and treatment delay. Early diagnosis achieves health benefits while reducing costs.
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Affiliation(s)
| | - Dennis Poon
- Department of Gastroenterology, Lincoln County Hospital, Lincoln, UK
| | - Laura L White
- Department of Medical Diagnostics, Lincoln County Hospital, Lincoln, UK
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22
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Abstract
BACKGROUND Visceral pain is a complex and heterogeneous disorder, which can range from the mild discomfort of indigestion to the agonizing pain of renal colic. Regulation of visceral pain involves the spinal cord as well as higher order brain structures. Recent findings have linked the microbiota to gastrointestinal disorders characterized by abdominal pain suggesting the ability of microbes to modulate visceral hypersensitivity and nociception to pain. MAIN BODY In this review we describe the neuroanatomical basis of visceral pain signaling and the existing evidence of its manipulation exerted by the gut microbiota. We included an updated overview of the potential therapeutic effects of dietary intervention, specifically probiotics and prebiotics, in alleviating hypersensitivity to visceral pain stimuli. CONCLUSIONS The gut microbiota dramatically impacts normal visceral pain sensation and affects the mechanisms mediating visceral nociception. Furthermore, manipulation of the gut microbiota using prebiotics and probiotics plays a potential role in the regulation of visceral pain disorders.
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Affiliation(s)
- Matteo M Pusceddu
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, One Shield Avenue, Davis, CA, USA.
| | - Melanie G Gareau
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, One Shield Avenue, Davis, CA, USA.
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23
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Krouwel M, Greenfield S, Farley A, Ismail T, Jolly K. Factors which affect the efficacy of hypnotherapy for IBS: Protocol for a systematic review and meta-regression. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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24
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Vitamin D status in irritable bowel syndrome and the impact of supplementation on symptoms: what do we know and what do we need to know? Eur J Clin Nutr 2018; 72:1358-1363. [PMID: 29367731 DOI: 10.1038/s41430-017-0064-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Low vitamin D status is associated with risk of colorectal cancer and has been implicated in inflammatory bowel disease. Irritable bowel syndrome (IBS) is a chronic, relapsing, functional bowel disorder. A nascent literature suggests a role for vitamin D in IBS, but this has not been collated or critiqued. To date, seven studies have been published: four observational studies and three randomised controlled trials (RCTs). All observational studies reported that a substantial proportion of the IBS population was vitamin D deficient. Two intervention studies reported improvement in IBS symptom severity scores and quality of life (QoL) with vitamin D supplementation. There are limited data around the role of vitamin D in IBS. CONCLUSIONS The available evidence suggests that low vitamin D status is common among the IBS population and merits assessment and rectification for general health reasons alone. An inverse correlation between serum vitamin D and IBS symptom severity is suggested and vitamin D interventions may benefit symptoms. However, the available RCTs do not provide strong, generalisable evidence; larger and adequately powered interventions are needed to establish a case for therapeutic application of vitamin D in IBS.
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25
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Radovanovic-Dinic B, Tesic-Rajkovic S, Grgov S, Petrovic G, Zivkovic V. Irritable bowel syndrome - from etiopathogenesis to therapy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:1-9. [PMID: 29358788 DOI: 10.5507/bp.2017.057] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/12/2017] [Indexed: 12/15/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a chronic and relapsing functional gastrointestinal disorder that affects 9-23% of the population across the world. Patients with IBS are often referred to gastroenterology, undergo various investigations, take various medicines, take time off work and have a poor quality of life. The pathophysiology of IBS is not yet completely understood and seems to be multifactorial. Many pathogenetic factors, in various combinations, and not all necessarily present in each patient, can play an important role. Discomfort or abdominal pain relieived by defacation, asociated with a change in stool form, is a typical clinical manifestation of IBS. Many factors, such as emotional stress and eating, may exacerbate the symptoms. A timely diagnosis of IBS is important so that treatment which will provide adequate symptomatic relief (diarrhoea, constipation, pain and boaring) can be introduced. The diagnosis of IBS is not confirmed by a specific test or structural abnormality. It is made using criteria based on clinical symptoms such as Rome criteria, unless the symptoms are thought to be atypical. Today the Rome Criteria IV is the current gold-standard for the diagnoses of IBS. Treatment of patients with IBS requires a multidisciplinary approach. Some patients respond well to non-pharmacological treatment, while others also require pharmacological treatment. This review will provide a summary of pathophysiology, diagnostic criteria and therapies for IBS.
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Affiliation(s)
- Biljana Radovanovic-Dinic
- Clinic for Gastroenterology and Hepatology, Clinical Centre Nis, Serbia.,Faculty of Medicine, University of Nis, Serbia
| | | | | | - Gordana Petrovic
- Clinic for Gastroenterology and Hepatology, Clinical Centre Nis, Serbia
| | - Valentina Zivkovic
- Faculty of Medicine, University of Nis, Serbia.,Institute for Treatment and Rehabilitation, Niska Banja, Serbia
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26
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Tang I, MacFaul G, Madhotra R, Rostami K. Post pancreatitis/cholecystectomy gluten intolerance. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2018; 11:273-275. [PMID: 30013753 PMCID: PMC6040032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/23/2018] [Indexed: 11/05/2022]
Abstract
This case report describes the journey of a patient who suffered from life-limiting gastrointestinal symptoms after an acute bout of pancreatitis following ERCP for cholelithiasis bile following a ductal stone, and subsequent cholecystectomy. She was diagnosed and treated for IBS with medication without significant improvement. On implementation of a simple gluten and lactose exclusion diet she recovered to her premorbid state, and trials of gluten challenge triggered flares of symptoms. This case report will go on to discuss current evidence for use of gluten and lactose exclusion diets in some gluten sensitive patients misdiagnosed with IBS.
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Affiliation(s)
- Ivan Tang
- Department of Gastroenterology, Hepatology and Nutrition, Milton Keynes University Hospital, United Kingdom
| | - George MacFaul
- Department of Gastroenterology, Hepatology and Nutrition, Milton Keynes University Hospital, United Kingdom
| | - Ravi Madhotra
- Department of Gastroenterology, Hepatology and Nutrition, Milton Keynes University Hospital, United Kingdom
| | - Kamran Rostami
- Department of Gastroenterology, Hepatology and Nutrition, Milton Keynes University Hospital, United Kingdom
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27
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Casella G, Villanacci V, Di Bella C, Bassotti G, Bold J, Rostami K. Non celiac gluten sensitivity and diagnostic challenges. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2018; 11:197-202. [PMID: 30013742 PMCID: PMC6040028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 05/18/2018] [Indexed: 11/05/2022]
Abstract
Non-celiac gluten sensitivity (NCGS), also referred to as non-celiac wheat sensitivity (NCWS), is a clinical syndrome characterized by both intestinal and extra-intestinal symptoms responsive to the withdrawal of gluten-containing food from the diet. The aim of this review is to summarize recent advances in research and provide a brief overview of the history of the condition for the benefit of professionals working in gastroenterology. Academic databases such as PubMed and Google Scholar were searched using key words such as "non-celiac gluten sensitivity", "gluten related disorders", and the studies outlined in reference page were selected and analysed. Most of the analysed studiers agree that NCGS would need to be diagnosed only after exclusion of celiac disease and wheat allergy, and that a reliable serological marker is not available presently. The mechanisms causing symptoms in NCGS after gluten ingestion are largely unknown, but recent advances have begun to offer novel insights. The estimated prevalence of NCGS, at present, varies between 0.6 and 6%. There is an overlap between irritable bowel syndrome and NCGS with regard to the similarity of gastrointestinal symptoms. The histologic characteristics of NCGS are still under investigation, ranging from normal histology to slight increase in the number of T lymphocytes in the superficial epithelium of villi. Positive response to gluten free diet for a limited period (e.g., 6 weeks), followed by the reappearance of symptoms after gluten challenge appears, at this moment, to be the best approach for confirming diagnosis. The Salerno expert criteria may help to diagnose NCGS accurately in particular for research purposes but it has limited applicability in clinical practice.
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Affiliation(s)
| | | | - Camillo Di Bella
- Pathology Department, Carate Brianza Hospital, ASST-Vimercate (Monza Brianza), Italy
| | - Gabrio Bassotti
- Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - Justine Bold
- Department of Gastroenterology Milton Keynes University Hospital, Milton Keynes, UK
| | - Kamran Rostami
- Allied Health and Social Sciences, University of Worcester, UK
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Rostami K, Bold J, Parr A, Johnson MW. Gluten-Free Diet Indications, Safety, Quality, Labels, and Challenges. Nutrients 2017; 9:nu9080846. [PMID: 28786929 PMCID: PMC5579639 DOI: 10.3390/nu9080846] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 12/22/2022] Open
Abstract
A gluten-free diet (GFD) is the safest treatment modality in patient with coeliac disease (CD) and other gluten-related disorders. Contamination and diet compliance are important factors behind persistent symptoms in patients with gluten related-disorders, in particular CD. How much gluten can be tolerated, how safe are the current gluten-free (GF) products, what are the benefits and side effects of GFD? Recent studies published in Nutrients on gluten-free products’ quality, availability, safety, as well as challenges related to a GFD are discussed.
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Affiliation(s)
- Kamran Rostami
- Department of Gastroenterology, Milton Keynes University Hospital, Milton Keynes MK6 5LD, UK.
| | - Justine Bold
- Allied Health and Social Sciences, Institute of Health and Society University of Worcester, Worcester WR2 6AJ, UK.
| | - Alison Parr
- Freelance Nutrition Therapist, Manchester M33 5PD, UK.
| | - Matt W Johnson
- Department of Gastroenterology, Luton and Dunstable University Hospital, Luton LU4 0DZ, UK.
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Williams M, Barclay Y, Benneyworth R, Gore S, Hamilton Z, Matull R, Phillips I, Seamark L, Staveley K, Thole S, Greig E. Using best practice to create a pathway to improve management of irritable bowel syndrome: aiming for timely diagnosis, effective treatment and equitable care. Frontline Gastroenterol 2016; 7:323-330. [PMID: 27761233 PMCID: PMC5036211 DOI: 10.1136/flgastro-2016-100727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) costs the National Health Service almost £12 million per annum. Despite national guidelines advising primary care management, these have failed to stem secondary care referrals of patients with likely IBS for unnecessary and costly assessment and investigation without necessarily achieving resolution of their symptoms. METHODS In 2011, an integrated team from primary and secondary care developed a business case using baseline data to create a Somerset-wide IBS pathway using Clinical Commissioning Group funding. This provided face-to-face general practitioners (GP) education, developed a diagnostic pathway and funded faecal calprotectin (FC) testing to exclude inflammatory pathology for patients aged 16-45 years with likely IBS and no alarm symptoms. For those with FC≤50 μg/g, we provided a management algorithm and community-based dietetic treatment. Audit results measured usage and outcomes from FC testing, changes in patterns and costs of new patients reviewed in gastroenterology outpatients and dietetic IBS treatment outcomes. RESULTS The proportion of new patient slots used reduced from 14.3% to 8.7% over 10 months while overall costs reduced by 25% for patients with no alarm symptoms and likely IBS aged 16-45 years. FC results confirmed research findings with no inflammatory pathology, if FC≤50 μg/g over 2 years. 63% of patients had satisfactory control of their IBS after specialist dietetic input with 74% reporting improved quality of life. CONCLUSIONS The combination of GP education, providing diagnosis and management pathways, using FC to exclude inflammatory pathology and providing an effective treatment for patients with likely IBS appeared successful in our pilot. This proved cost-effective, reduced secondary care involvement and improved patient care.
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Affiliation(s)
- Marianne Williams
- Department of Community Dietitian, Somerset Partnership NHS Trust, Bridgwater, UK
| | - Yvonne Barclay
- Department of Community Dietitian, Somerset Partnership NHS Trust, Bridgwater, UK
| | | | - Steve Gore
- Yeovil District NHS Foundation Trust, Yeovil, UK
| | - Zoe Hamilton
- Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | - Rudi Matull
- Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | - Iain Phillips
- Somerset Clinical Commissioning Group, Wincanton, UK
| | - Leah Seamark
- Department of Community Dietitian, Somerset Partnership NHS Trust, Bridgwater, UK
| | | | | | - Emma Greig
- Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
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