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de Graaf MCG, Lawton CL, Croden F, Smolinska A, Winkens B, Hesselink MAM, van Rooy G, Weegels PL, Shewry PR, Houghton LA, Witteman BJM, Keszthelyi D, Brouns FJPH, Dye L, Jonkers DMAE. The effect of expectancy versus actual gluten intake on gastrointestinal and extra-intestinal symptoms in non-coeliac gluten sensitivity: a randomised, double-blind, placebo-controlled, international, multicentre study. Lancet Gastroenterol Hepatol 2024; 9:110-123. [PMID: 38040019 DOI: 10.1016/s2468-1253(23)00317-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Many individuals without coeliac disease or wheat allergy reduce their gluten intake because they believe that gluten causes their gastrointestinal symptoms. Symptoms could be affected by negative expectancy. Therefore, we aimed to investigate the effects of expectancy versus actual gluten intake on symptoms in people with non-coeliac gluten sensitivity (NCGS). METHODS This randomised, double-blind, placebo-controlled, international, multicentre study was done at the University of Leeds (Leeds, UK), Maastricht University (Maastricht, the Netherlands), and Wageningen University and Research (Wageningen, the Netherlands). People aged 18-70 years with self-reported NCGS (ie, gastrointestinal symptoms within 8 h of gluten consumption) without coeliac disease and wheat allergy were recruited. Participants had to follow a gluten-free or gluten-restricted diet for at least 1 week before (and throughout) study participation and had to be asymptomatic or mildly symptomatic (overall gastrointestinal symptom score ≤30 mm on the Visual Analogue Scale [VAS]) while on the diet. Participants were randomly assigned (1:1:1:1; blocks of eight; stratified by site and gender) to one of four groups based on the expectation to consume gluten-containing (E+) or gluten-free (E-) oat bread for breakfast and lunch (two slices each) and actual intake of gluten-containing (G+) or gluten-free (G-) oat bread. Participants, investigators, and those assessing outcomes were masked to the actual gluten assignment, and participants were also masked to the expectancy part of the study. The primary outcome was overall gastrointestinal symptom score on the VAS, which was measured at and corrected for baseline (before breakfast) and hourly for 8 h, with lunch served after 4 h, and analysed per-protocol. Safety analysis included all participants incorporated in the per-protocol analysis. The study is registered at ClinicalTrials.gov, NCT05779358, and has ended. FINDINGS Between Oct 19, 2018, and Feb 14, 2022, 165 people were screened and 84 were randomly assigned to E+G+ (n=21), E+G- (n=21), E-G+ (n=20), or E-G- (n=22). One person in the E+G+ group was excluded due to not following test day instructions, leaving 83 participants in the per-protocol analysis. Median age was 27·0 years (IQR 21·0-45·0), 71 (86%) of 83 people were women, and 12 (14%) were men. Mean overall gastrointestinal symptom score was significantly higher for E+G+ (16·6 mm [95% CI 13·1 to 20·0]) than for E-G+ (6·9 mm [3·5 to 10·4]; difference 9·6 mm [95% CI 3·0 to 16·2], p=0·0010) and E-G- (7·4 mm [4·2 to 10·7]; difference 9·1 mm [2·7 to 15·6], p=0·0016), but not for E+G- (11·7 mm [8·3 to 15·1]; difference 4·9 mm [-1·7 to 11·5], p=0·28). There was no difference between E+G- and E-G+ (difference 4·7 mm [-1·8 to 11·3], p=0·33), E+G- and E-G- (difference 4·2 mm [-2·2 to 10·7], p=0·47), and E-G+ and E-G- (difference -0·5 mm [-7·0 to 5·9], p=1·0). Adverse events were reported by two participants in the E+G- group (itching jaw [n=1]; feeling lightheaded and stomach rumbling [n=1]) and one participant in the E-G+ group (vomiting). INTERPRETATION The combination of expectancy and actual gluten intake had the largest effect on gastrointestinal symptoms, reflecting a nocebo effect, although an additional effect of gluten cannot be ruled out. Our results necessitate further research into the possible involvement of the gut-brain interaction in NCGS. FUNDING Government of the Netherlands Topsector Agri & Food Top Consortium for Knowledge and Innovation, AB Mauri Global Bakery Ingredients, Baking Industry Research Trust, Borgesius-Albert Heijn, CSM Innovation Centre, the International Maize and Wheat Improvement Center (CIMMYT), DSM Food Specialties, Fazer, Healthgrain Forum, the International Association for Cereal Science and Technology, the International Wheat Gluten Association, Lantmännen, Mondelez International, Nederlands Bakkerij Centrum, Nutrition & Santé, Puratos, Rademaker, Sonneveld Group, and Zeelandia HJ Doeleman.
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Affiliation(s)
- Marlijne C G de Graaf
- Department of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | | | - Fiona Croden
- School of Psychology, University of Leeds, Leeds, UK
| | - Agnieszka Smolinska
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands; Department of Pharmacology and Toxicology, Maastricht University, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Martine A M Hesselink
- Department of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Gonny van Rooy
- Department of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Peter L Weegels
- Laboratory of Food Chemistry, Wageningen University and Research, Wageningen, Netherlands; European Bakery Innovation Centre, Sonneveld Group, Papendrecht, Netherlands
| | | | - Lesley A Houghton
- Division of Gastroenterology and Surgical Sciences, Leeds Institute of Medical Research, University of Leeds, Leeds, UK; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Ben J M Witteman
- Division of Human Nutrition, Wageningen University and Research, Wageningen, Netherlands; Division of Gastroenterology-Hepatology, Gelderse Vallei Hospital, Ede, Netherlands
| | - Daniel Keszthelyi
- Department of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Fred J P H Brouns
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands; Department of Human Biology, Maastricht University, Maastricht, Netherlands
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds, UK; School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Daisy M A E Jonkers
- Department of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.
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Snijkers JTW, Winkens B, Weerts ZZRM, Vork L, Mujagic Z, Hesselink MAM, Leue C, Kruimel JW, Muris JWM, Jonkers DMAE, Masclee AAM, Keszthelyi D. Satisfaction With Life in IBS Is Associated With Psychological Burden Rather than Gastrointestinal Symptom Severity. Am J Gastroenterol 2023:00000434-990000000-00906. [PMID: 37791610 PMCID: PMC10904003 DOI: 10.14309/ajg.0000000000002547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) has a major impact on emotional, social, and professional life. This study aimed to evaluate general life satisfaction, a subjective measure of well-being, in IBS patients, and to determine which factors are associated with higher life satisfaction. METHODS IBS patients (n = 195, mean age 51.4 ± 16.5 years, 73.8% female) recruited from primary and secondary/tertiary care completed questionnaires regarding gastrointestinal symptoms, quality of life, psychological factors, and life satisfaction (Satisfaction With Life Scale, 5 items, range 5-35). A finite mixture model analysis was performed to identify latent classes. Multivariable linear regression was used to identify variables associated with life satisfaction. RESULTS Overall, 71.3% of the patients were satisfied about their life (Satisfaction With Life Scale-score ≥21). Three latent subgroups could be identified with significantly higher life satisfaction in the subgroup with higher mental quality of life, fewer anxiety and depressive symptoms, lower gastrointestinal specific anxiety, and lower gastrointestinal symptom severity, compared with the other 2 groups. Multivariable linear regression showed that higher physical quality of life (B0.168, P < 0.001) and higher mental quality of life (B0.199, P < 0.001) were associated with higher life satisfaction. Using multivariable regression, no significant association was found between gastrointestinal symptom severity and life satisfaction. DISCUSSION Higher physical and mental quality of life, but not gastrointestinal symptom severity, were independently associated with higher general life satisfaction in IBS. These findings reinforce the clinical need in IBS treatment to focus on the full extent of the disorder and not merely on gastrointestinal symptom improvement. ClinicalTrials.gov Identifier: NCT00775060.
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Affiliation(s)
- Johanna T W Snijkers
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Zsa Zsa R M Weerts
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Lisa Vork
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Zlatan Mujagic
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Martine A M Hesselink
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Carsten Leue
- MHeNS, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Psychiatry and Medical Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Joanna W Kruimel
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Daisy M A E Jonkers
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Ad A M Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
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de Graaf MCG, Spooren CEGM, Hendrix EMB, Hesselink MAM, Feskens EJM, Smolinska A, Keszthelyi D, Pierik MJ, Mujagic Z, Jonkers DMAE. Diet Quality and Dietary Inflammatory Index in Dutch Inflammatory Bowel Disease and Irritable Bowel Syndrome Patients. Nutrients 2022; 14:nu14091945. [PMID: 35565912 PMCID: PMC9101333 DOI: 10.3390/nu14091945] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 02/01/2023] Open
Abstract
Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) share common culprit foods and potential pathophysiological factors. However, how diet may contribute to disease course and whether this differs between both entities is unclear. We therefore investigated the association of dietary indices with intestinal inflammation and gastrointestinal symptoms in both IBD and IBS patients. Food frequency questionnaires from 238 IBD, 261 IBS and 195 healthy controls (HC) were available to calculate the overall diet quality by the Dutch Healthy Diet-Index 2015 (DHD-2015) and its inflammatory potential by the Adapted Dietary Inflammatory Index (ADII). Intestinal inflammation and symptoms were evaluated by faecal calprotectin and the Gastrointestinal Symptom Rating Scale, respectively. The DHD-2015 was lower in IBD and IBS versus HC (p < 0.001), being associated with calprotectin levels in IBD (b = −4.009, p = 0.006), and with abdominal pain (b = −0.012, p = 0.023) and reflux syndrome (b = −0.016, p = 0.004) in IBS. ADII scores were comparable between groups and were only associated with abdominal pain in IBD (b = 0.194, p = 0.004). In this side-by-side comparison, we found a lower diet quality that was differentially associated with disease characteristics in IBD versus IBS patients. Longitudinal studies are needed to further investigate the role of dietary factors in the development of flares and predominant symptoms.
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Affiliation(s)
- Marlijne C. G. de Graaf
- Division Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (C.E.G.M.S.); (E.M.B.H.); (M.A.M.H.); (D.K.); (M.J.P.); (Z.M.); (D.M.A.E.J.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Correspondence: ; Tel.: +31-4338-84237
| | - Corinne E. G. M. Spooren
- Division Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (C.E.G.M.S.); (E.M.B.H.); (M.A.M.H.); (D.K.); (M.J.P.); (Z.M.); (D.M.A.E.J.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Evelien M. B. Hendrix
- Division Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (C.E.G.M.S.); (E.M.B.H.); (M.A.M.H.); (D.K.); (M.J.P.); (Z.M.); (D.M.A.E.J.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Martine A. M. Hesselink
- Division Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (C.E.G.M.S.); (E.M.B.H.); (M.A.M.H.); (D.K.); (M.J.P.); (Z.M.); (D.M.A.E.J.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Department of Agrotechnology and Food Sciences, Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands;
| | - Agnieszka Smolinska
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Department of Pharmacology and Toxicology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Daniel Keszthelyi
- Division Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (C.E.G.M.S.); (E.M.B.H.); (M.A.M.H.); (D.K.); (M.J.P.); (Z.M.); (D.M.A.E.J.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Marieke J. Pierik
- Division Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (C.E.G.M.S.); (E.M.B.H.); (M.A.M.H.); (D.K.); (M.J.P.); (Z.M.); (D.M.A.E.J.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Zlatan Mujagic
- Division Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (C.E.G.M.S.); (E.M.B.H.); (M.A.M.H.); (D.K.); (M.J.P.); (Z.M.); (D.M.A.E.J.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Daisy M. A. E. Jonkers
- Division Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (C.E.G.M.S.); (E.M.B.H.); (M.A.M.H.); (D.K.); (M.J.P.); (Z.M.); (D.M.A.E.J.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
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Snijkers JTW, van den Oever W, Weerts ZZRM, Vork L, Mujagic Z, Leue C, Hesselink MAM, Kruimel JW, Muris JWM, Bogie RMM, Masclee AAM, Jonkers DMAE, Keszthelyi D. Examining the optimal cutoff values of HADS, PHQ-9 and GAD-7 as screening instruments for depression and anxiety in irritable bowel syndrome. Neurogastroenterol Motil 2021; 33:e14161. [PMID: 33938601 PMCID: PMC9285971 DOI: 10.1111/nmo.14161] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Self-rating scales are frequently used to screen for anxiety and depression in patients with irritable bowel syndrome (IBS). Different cutoff values are recommended in literature, and guidelines have suggested the use of other screening instruments over time. The aim of this study was to assess the correlation between the most commonly used psychological screening instruments for anxiety and depression in IBS and to compare custom cutoff scores for these instruments. METHODS Irritable bowel syndrome patients (n = 192) completed several questionnaires including the Hospital Anxiety and Depression Scale (HADS, HADS-A and HADS-D subscale), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Agreement at different cutoff points, for depressive and anxiety disorder, was assessed by use of the Gwet AC1 coefficient. KEY RESULTS Hospital Anxiety and Depression Scale (HADS)-D and PHQ-9 scores, and HADS-A and GAD-7 scores showed high correlations (rs = 0.735 and rs = 0.805, respectively). For depressive disorder, a Gwet AC1 value of 0.829 was found when recommended cutoff points from literature were compared (PHQ-9 cutoff ≥10, HADS-D cutoff ≥8). For anxiety disorder, a Gwet AC1 value of 0.806 was found when recommended cutoff points from literature were compared (GAD-7 cutoff ≥10, HADS-A cutoff ≥8). Even higher agreements were found when higher HADS cutoff values were chosen, with impact on sensitivity and specificity. CONCLUSIONS & INFERENCES Custom cutoff values deem the HADS subscales (HADS-D and HADS-A) concordant to PHQ-9 and GAD-7 scores. The choice of a cutoff value has substantial impact on sensitivity/specificity and is dependent on patient population, setting, and the purpose of use.
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Affiliation(s)
- Johanna T. W. Snijkers
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Wendy van den Oever
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Zsa Zsa R. M. Weerts
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Lisa Vork
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Zlatan Mujagic
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Carsten Leue
- Department of Psychiatry and PsychologyMaastricht University Medical Center+MaastrichtThe Netherlands,MHeNSSchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Martine A. M. Hesselink
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Joanna W. Kruimel
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Jean W. M. Muris
- Department of Family MedicineCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Roel M. M. Bogie
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,GROWSchool for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Ad A. M. Masclee
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Daisy M. A. E. Jonkers
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
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Weerts ZZRM, Vork L, Mujagic Z, Keszthelyi D, Hesselink MAM, Kruimel J, Leue C, Muris JW, Jonkers DMAE, Masclee AAM. Reduction in IBS symptom severity is not paralleled by improvement in quality of life in patients with irritable bowel syndrome. Neurogastroenterol Motil 2019; 31:e13629. [PMID: 31119844 PMCID: PMC6852246 DOI: 10.1111/nmo.13629] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/23/2019] [Accepted: 05/03/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a brain-gut disorder, of which the natural course varies between patients and is difficult to predict. This study aimed to evaluate symptom evolution over a 5-year follow-up period and to identify baseline predictors for symptom severity and quality of life (QoL) at follow-up. METHODS Maastricht IBS cohort participants completed questionnaires upon inclusion regarding demographics and lifestyle, gastrointestinal (GI) symptoms, anxiety and depression, and QoL. The same questionnaires, in addition to others, were completed after 5 years. Rome criteria were confirmed face-to-face at initial enrollment and through telephonic interviews at follow-up. KEY RESULTS At a mean follow-up of 4.7 years, 379 patients were approached of whom 203 (53.7%) responded. Of these, 161 were reached by telephone and analyzed; 49 (30.4%) did not fulfill the Rome III criteria at follow-up and had lower levels of GI symptoms and GI-specific anxiety compared to those remaining Rome III-positive (P < 0.001). However, Rome III-negative patients had comparable levels of QoL and life satisfaction, comorbid anxiety and depression, work absenteeism, and impaired productivity. No baseline predictors were found for being Rome III-positive or Rome III-negative. However, greater age and lower baseline physical QoL predicted lower physical QoL at follow-up (P < 0.005 and P < 0.01, respectively), while lower baseline mental QoL predicted lower mental QoL at follow-up (P = 0.005). Additionally, higher anxiety and depression scores at follow-up were associated with lower QoL and life satisfaction at follow-up (P < 0.001). CONCLUSIONS AND INFERENCES Long-term QoL and general well-being might depend on concurrent psychological symptoms, rather than GI symptom improvement.
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Affiliation(s)
- Zsa Zsa R. M. Weerts
- Division of Gastroenterology‐HepatologyNUTRIM, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Lisa Vork
- Division of Gastroenterology‐HepatologyNUTRIM, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Zlatan Mujagic
- Division of Gastroenterology‐HepatologyNUTRIM, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology‐HepatologyNUTRIM, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Martine A. M. Hesselink
- Division of Gastroenterology‐HepatologyNUTRIM, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Joanna Kruimel
- Division of Gastroenterology‐HepatologyNUTRIM, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Carsten Leue
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Jean W.M. Muris
- Department of Family MedicineCare and Public Health Research Institute (CAPHRI), Maastricht UniversityMaastrichtThe Netherlands
| | - Daisy M. A. E. Jonkers
- Division of Gastroenterology‐HepatologyNUTRIM, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Ad A. M. Masclee
- Division of Gastroenterology‐HepatologyNUTRIM, Maastricht University Medical CenterMaastrichtThe Netherlands
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Vork L, Mujagic Z, Drukker M, Keszthelyi D, Conchillo JM, Hesselink MAM, van Os J, Masclee AAM, Leue C, Kruimel JW. The Experience Sampling Method-Evaluation of treatment effect of escitalopram in IBS with comorbid panic disorder. Neurogastroenterol Motil 2019; 31:e13515. [PMID: 30460734 PMCID: PMC7379179 DOI: 10.1111/nmo.13515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/16/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Confirming treatment response in clinical trials for irritable bowel syndrome (IBS) is challenging, due to the lack of biomarkers and limitations of the currently available symptom assessment tools. The Experience Sampling Method (ESM) might overcome these limitations by collecting digital assessments randomly and repeatedly during daily life. This study evaluated differences in change in abdominal pain between real-time (ie, ESM) and retrospective (ie, Gastrointestinal Symptom Rating Scale [GSRS] and an end-of-day symptom diary) measurements, using data of an RCT on escitalopram vs placebo in patients with IBS and comorbid panic disorder. METHODS Twenty-nine IBS patients with comorbid panic disorder were included in a 6-month RCT. The GSRS, diary, and ESM were completed at baseline (t = 0) and after 3 (t = 3) and 6 months (t = 6). Linear mixed models were used. KEY RESULTS Experience Sampling Method analyses revealed a significant interaction between escitalopram and time, and ESM abdominal pain scores were 1.4 points lower in the escitalopram group compared to placebo at t = 6 (on a 1-to-7 scale; P = 0.021). When including the interaction with momentary anxiety, the reduction in abdominal pain scores in escitalopram vs placebo was even more pronounced for higher levels of anxiety. Average GSRS- and end-of-day abdominal pain scores were not significantly different between escitalopram and placebo at t = 3 and 6. CONCLUSIONS & INFERENCES Real-time ESM has the potential to capture treatment response more sensitively compared to a retrospective end-of-day GI symptom diary and the GSRS, by taking into account day-to-day symptom variability as well as momentary factors that might moderate treatment effect, such as anxiety.
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Affiliation(s)
- Lisa Vork
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Zlatan Mujagic
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Marjan Drukker
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - José M. Conchillo
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Martine A. M. Hesselink
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Jim van Os
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtThe Netherlands,Department of PsychiatryBrain Centre Rudolf Magnus, Utrecht University Medical CenterUtrechtThe Netherlands,King's College London, King's Health PartnersDepartment of Psychosis StudiesInstitute of PsychiatryLondonUK
| | - Ad A. M. Masclee
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Carsten Leue
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Joanna W. Kruimel
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
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Vork L, Weerts ZZRM, Mujagic Z, Kruimel JW, Hesselink MAM, Muris JWM, Keszthelyi D, Jonkers DMAE, Masclee AAM. Rome III vs Rome IV criteria for irritable bowel syndrome: A comparison of clinical characteristics in a large cohort study. Neurogastroenterol Motil 2018; 30. [PMID: 28804974 DOI: 10.1111/nmo.13189] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/20/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Rome criteria for irritable bowel syndrome (IBS) have been revised and are expected to apply only to the subset of Rome III IBS subjects with abdominal pain as predominant symptom, occurring at least once a week. The aim of this study was to determine the percentage of Rome III IBS subjects that fulfills Rome IV criteria and to evaluate differences between Rome IV-positive and Rome IV-negative subjects. METHODS Four hundred and four Rome III IBS subjects completed a 14-day end-of-day symptom diary, the Gastrointestinal Symptom Rating Scale (GSRS), Hospital Anxiety and Depression Scale, and RAND 36-item Short-Form Health Survey (SF-36). Diary-based surrogate Rome IV criteria were defined as occurrence of abdominal pain at least 1 day each week with a severity of ≥2 (mild; definition 1) or ≥3 (considerable; definition 2). KEY RESULTS Using surrogate Rome IV criteria, 353 (87.4%, definition 1) and 249 (61.6%, definition 2) subjects were defined as Rome IV positive. These patients were more often female, younger, and recruited from secondary/tertiary care compared with Rome IV-negative subjects. They also presented with higher abdominal pain scores and gastrointestinal (GI) symptom severity on both end-of-day diary and GSRS, higher psychological symptom scores, and lower quality of life compared with Rome IV-negative subjects. CONCLUSIONS AND INFERENCES The Rome IV IBS population likely reflects a subgroup of Rome III IBS patients with more severe GI symptomatology, psychological comorbidities, and lower quality of life. This implies that results from Rome III IBS studies may not be directly comparable to those from Rome IV IBS populations.
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Affiliation(s)
- L Vork
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Z Z R M Weerts
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Z Mujagic
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J W Kruimel
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M A M Hesselink
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J W M Muris
- Department of Family Medicine, CAPHRI Care And Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - D Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D M A E Jonkers
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A A M Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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Tigchelaar EF, Mujagic Z, Zhernakova A, Hesselink MAM, Meijboom S, Perenboom CWM, Masclee AAM, Wijmenga C, Feskens EJM, Jonkers DMAE. Habitual diet and diet quality in Irritable Bowel Syndrome: A case-control study. Neurogastroenterol Motil 2017; 29. [PMID: 28714091 DOI: 10.1111/nmo.13151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/09/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diet is considered to be a key factor in symptom generation in Irritable Bowel Syndrome (IBS) and patients tend to exclude food products from their diet in pursue of symptom relief, which may impair diet quality. METHODS We evaluated habitual dietary intake in IBS patients with regard to nutrients and food products using an extensive food frequency questionnaire. One hundred ninety-four IBS patients were compared to 186 healthy controls using multiple logistic regression analysis. An overall diet quality score was calculated for each participant based on the criteria of the Dutch Healthy Diet (DHD) index. KEY RESULTS A lower DHD-score was found for IBS (mean [SD]: 52.9 [9.6]) vs controls (55.1 [9.2], P=.02). The diet of patients was lower in fibers (21 g vs 25 g per day, P=.002) and fructose (14 g vs 16 g, P=.033), while higher in total fat (37% vs 36% of total energy intake, P=.010) and added sugars (46 g vs 44 g, P=.029). Differences in daily intake of food products included lower consumption of apples (40 g vs 69 g, P<.001), pasta (28 vs 37 g, P=.029) and alcoholic beverages (130 g vs 193 g, P=.024) and higher consumption of processed meat (38 g vs 29 g, P<.001). Some of these findings correlated with gastrointestinal symptoms, showing differences between IBS subtypes. CONCLUSIONS AND INFERENCES Differences in habitual diet were described, showing lower diet quality in IBS patients compared to controls, with increased consumption of fat and lower intake of fibers and fructose. Our data support the importance of personalized and professional nutritional guidance of IBS patients.
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Affiliation(s)
- E F Tigchelaar
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands
| | - Z Mujagic
- Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands.,Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A Zhernakova
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands
| | - M A M Hesselink
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - S Meijboom
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - C W M Perenboom
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - A A M Masclee
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - C Wijmenga
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands
| | - E J M Feskens
- Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands.,Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - D M A E Jonkers
- Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands.,Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
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Mujagic Z, Ludidi S, Keszthelyi D, Hesselink MAM, Kruimel JW, Lenaerts K, Hanssen NMJ, Conchillo JM, Jonkers DMAE, Masclee AAM. Small intestinal permeability is increased in diarrhoea predominant IBS, while alterations in gastroduodenal permeability in all IBS subtypes are largely attributable to confounders. Aliment Pharmacol Ther 2014; 40:288-97. [PMID: 24943095 DOI: 10.1111/apt.12829] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 04/21/2014] [Accepted: 05/19/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intestinal permeability has been studied in small groups of IBS patients with contrasting findings. AIMS To assess intestinal permeability at different sites of the GI tract in different subtypes of well-characterised IBS patients and healthy controls (HC), and to assess potential confounding factors. METHODS IBS patients and HC underwent a multi-sugar test to assess site-specific intestinal permeability. Sucrose excretion and lactulose/rhamnose ratio in 0-5 h urine indicated gastroduodenal and small intestinal permeability, respectively. Sucralose/erythritol ratio in 0-24 h and 5-24 h urine indicated whole gut and colonic permeability, respectively. Linear regression analysis was used to assess the association between IBS groups and intestinal permeability and to adjust for age, sex, BMI, anxiety or depression, smoking, alcohol intake and use of medication. RESULTS Ninety-one IBS patients, i.e. 37% IBS-D, 23% IBS-C, 33% IBS-M and 7% IBS-U and 94 HC were enrolled. Urinary sucrose excretion was significantly increased in the total IBS group [μmol, median (Q1;Q3): 5.26 (1.82;11.03) vs. 2.44 (0.91;5.85), P < 0.05], as well as in IBS-C and IBS-D vs. HC. However, differences attenuated when adjusting for confounders. The lactulose/rhamnose ratio was increased in IBS-D vs. HC [0.023 (0.013;0.038) vs. 0.014 (0.008;0.025), P < 0.05], which remained significant after adjustment for confounders. No difference was found in 0-24 and 5-24 h sucralose/erythritol ratio between groups. CONCLUSIONS Small intestinal permeability is increased in patients with IBS-D compared to healthy controls, irrespective of confounding factors. Adjustment for confounders is necessary when studying intestinal permeability, especially in a heterogeneous disorder such as IBS.
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Affiliation(s)
- Z Mujagic
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
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