Evaluation of gallbladder contractility and Doppler findings in patients with irritable bowel syndrome; a case-control study

BACKGROUND

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder causing abdominal pain, altered bowel habits and bloating without structural issues. Gallbladder dysfunction may be linked to IBS due to disrupted cholecystokinin release. This study aims to assess gallbladder function and related hemodynamic parameters using Doppler ultrasound in IBS before and after meals.

METHOD

In this case-control study, we investigated gallbladder function differences between constipation-predominant IBS (C-IBS) patients and healthy volunteers. Participants underwent ultrasonography to measure gallbladder parameters before and after consuming a predefined meal. Gallbladder volume, wall thickness and resistance index (RI) of cystic and superior mesenteric arteries (SMA) were assessed. Student t-test and paired t-test were used to compare case and control groups and pre- and post-meal data, respectively.

RESULTS

A total of 34 people (18 C-IBS and 16 healthy control) were included. The mean (Standard deviation) of gallbladder fasting volume was measured 24.74 (8.85) and 29.73 (9.65) cubic millimeter for case and controls, respectively. Postprandial volume was 11.34 (5.66) and 16.9 (6.16) cubic millimeter for case and controls respectively. We observed a statistically significant difference in emptying fractions (EF) between groups (p value = 0.009). IBS patients had a smaller fasting SMA RI (p value = 0.016) but the fraction of change after meal was not significant (p value = 0.10). The cystic artery RI did not reach statistical significance between the fasting and post-meal values (p value = 0.067).

CONCLUSION

IBS patients have a higher emptying fraction and lower change in SMA RI compared to healthy controls. Further studies with larger sample size, inclusion of patients with different coexisting conditions and subtypes of IBS and combining colon transit study with gallbladder ejection fraction evaluation can be used to further provide more meaning to this study.

Brain activity in response to food images in patients with irritable bowel syndrome and functional dyspepsia

BACKGROUND

Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are caused and exacerbated by consumption of fatty foods. However, no study has evaluated brain activity in response to food images in patients with disorders of gut-brain interaction (DGBI). This study aimed to compare food preference and brain activity when viewing food images between patients with DGBI and healthy controls.

METHODS

FD and IBS were diagnosed using the ROME IV criteria. Food preference was assessed using a visual analog scale (VAS). Brain activity in the prefrontal cortex (PFC) in response to food images was investigated using functional near-infrared spectroscopy (fNIRS).

RESULTS

Forty-one patients were enrolled, including 25 with DGBI. The mean VAS scores for all foods (controls vs. FD vs. IBS: 69.1 ± 3.3 vs. 54.8 ± 3.8 vs. 62.8 ± 3.7, p = 0.02), including fatty foods (78.1 ± 5.4 vs. 43.4 ± 6.3 vs. 64.7 ± 6.1, p < 0.01), were the lowest in patients with FD among all groups. Patients with FD had significantly higher brain activity in the left PFC than those with IBS and healthy controls (mean z-scores in controls vs. FD vs. IBS: - 0.077 ± 0.03 vs. 0.125 ± 0.04 vs. - 0.002 ± 0.03, p < 0.001).

CONCLUSIONS

Patients with DGBI, particularly those with FD, disliked fatty foods. The brain activity in patients with DGBI differed from that in healthy controls. Increased activity in the PFC of patients with FD was confirmed.

Ultrasonographic and Functional Features of Symptomatic Uncomplicated Diverticular Disease

INTRODUCTION

To evaluate the ability of intestinal ultrasound (IUS) in discriminating symptomatic uncomplicated diverticular disease (SUDD) among patients with abdominal symptoms including irritable bowel syndrome (IBS).

METHODS

This observational, prospective study included consecutive patients classified into the following categories: (i) SUDD; (ii) IBS; (iii) unclassifiable abdominal symptoms; and (iv) controls, including asymptomatic healthy subjects and diverticulosis. The IUS evaluation of the sigmoid: assessed the presence of diverticula, thickness of the muscularis propria, and IUS-evoked pain, namely the intensity of pain evoked by compression with the ultrasound probe on sigmoid colon compared with an area of the left lower abdominal quadrant without underlying sigmoid colon.

RESULTS

We enrolled 40 patients with SUDD, 20 patients with IBS, 28 patients with unclassifiable abdominal symptoms, 10 healthy controls, and 20 patients with diverticulosis. Patients with SUDD displayed significantly ( P < 0.001) greater muscle thickness (2.25 ± 0.73 mm) compared with patients with IBS (1.66 ± 0.32 mm), patients with unclassifiable abdominal pain, and healthy subjects, but comparable with that of patients with diverticulosis (2.35 ± 0.71 mm). Patients with SUDD showed a greater (not significant) differential pain score than other patients. There was a significant correlation between the thickness of the muscularis propria and the differential pain score only for patients with SUDD ( r = 0.460; P : 0.01). Sigmoid diverticula were detected by colonoscopy in 40 patients (42.4%) and by IUS with a sensitivity of 96.0% and a specificity of 98.5%.

DISCUSSION

IUS could represent a useful diagnostic tool for SUDD, potentially useful in characterizing the disease and appropriately address the therapeutic approach.

Sex-specific brain microstructural reorganization in irritable bowel syndrome

ABSTRACT

Preliminary evidence suggests that there are sex differences in microstructural brain organization among individuals with irritable bowel syndrome (IBS). The aim of this study was to further investigate sex-dependent differences in brain microstructure and organization in a large sample of well-phenotyped participants with IBS compared with healthy controls. We hypothesized that female patients with IBS would show evidence for increased axonal strength and myelination within and between brain regions concerned with pain and sensory processing, when compared with males with IBS. We also hypothesized that female compared with male IBS subjects show greater levels of somatic awareness and sensory sensitivity consistent with multisystem sensory sensitivity. Diffusion tensor images and clinical assessments were obtained in 100 healthy controls (61 females) and 152 IBS (107 females) on a 3T Siemens Trio. Whole brain voxel-wise differences in fractional anisotropy, mean, radial and axial diffusivity, and track density as differences in somatic awareness and sensory sensitivity were assessed using the general linear model. Female compared with male IBS participants showed extensive microstructural alterations in sensorimotor, corticothalamic, and basal ganglia circuits involved in pain processing and integration of sensorimotor information. Together with the observed increases in symptom severity, somatic awareness, and sensory sensitivity, the findings support the hypotheses that the etiology and maintenance of symptoms in females with IBS may be driven by greater central sensitivity for multiple sensory stimuli.

[Dynamic characteristics of brain networks in patients with irritable bowel syndrome based on functional magnetic resonance imaging]

The disorder of brain-gut interaction is an important cause of irritable bowel syndrome (IBS), but the dynamic characteristics of the brain remain unclear. Since there are many shortcomings for evaluating brain dynamic nature in the previous studies, we proposed a new method based on slope calculation by point-by-point analysis of the data from functional magnetic resonance imaging, and detected the abnormalities of brain dynamic changes in IBS patients. The results showed that compared with healthy subjects, there were dynamic changes in the brain for the IBS patients. After correction by false discovery rate (FDR), significant abnormalities were only found in two functional connections of the right posterior cingulate gyrus linked to left middle frontal gyrus, and the right posterior cingulate gyrus linked to left pallidus. The above results of the brain dynamic analysis were totally different from those of the brain static analysis of IBS patients. Our findings provide novel complementary information for illustrating the central nervous mechanism of IBS and may offer a new direction to explore central target for patients with IBS.

Association between pain sensitivity and gray matter properties in the sensorimotor network in women with irritable bowel syndrome

BACKGROUND

Enhanced perception of visceral stimuli is an important feature of Irritable Bowel Syndrome (IBS), but it is not known whether visceral sensitivity is associated with regional structural brain properties in IBS.

METHODS

Structural brain magnetic resonance imaging data from 216 women with IBS and 138 healthy women were parcellated with FreeSurfer to define regional gray matter morphometry (volume, cortical thickness, surface area and mean curvature) in the sensorimotor network. General linear models were used to detect group differences between IBS and health. In a second set of 48 female IBS patients, pain threshold, pain intensity ratings during rectal balloon distension, and reported levels of abdominal pain and bloating were correlated with brain regions that showed differences between IBS and health in the first data set.

KEY RESULTS

Several statistically significant differences between IBS patients and healthy controls were found, mainly higher gray matter volume and cortical thickness in primary somatosensory cortex, secondary somatosensory cortex, and subcortical regions, and lesser gray matter volume, surface area and cortical thickness in posterior insula and superior frontal gyrus. Pain intensity ratings during rectal distension were associated with left primary somatosensory cortical thickness, and pain threshold was associated with right nucleus accumbens volume.

CONCLUSIONS AND INFERENCES

Regional gray matter differences in sensorimotor network are associated with visceral sensitivity and may represent neuroplastic changes in female IBS patients.

Altered brain structural connectivity in patients with longstanding gut inflammation is correlated with psychological symptoms and disease duration

OBJECTIVE

We aimed to identify differences in network properties of white matter microstructure between asymptomatic ulcerative colitis (UC) participants who had a history of chronic gut inflammation, healthy controls (HCs) and a disease control group without gut inflammation (irritable bowel syndrome; IBS).

DESIGN

Diffusion weighted imaging was conducted in age and sex-matched participants with UC, IBS, and HCs (N = 74 each), together with measures of gastrointestinal and psychological symptom severity. Using streamline connectivity matrices and graph theory, we aimed to quantify group differences in brain network connectivity. Regions showing group connectivity differences were correlated with measures showing group behavioral and clinical differences.

RESULTS

UC participants exhibited greater centrality in regions of the somatosensory network and default mode network, but lower centrality in the posterior insula and globus pallidus compared to HCs (q < 0.05). Hub analyses revealed compromised hubness of the pallidus in UC and IBS compared to HCs which was replaced by increased hubness of the postcentral sulcus. Surprisingly, few differences in network matrices between UC and IBS were identified. In UC, centrality measures in the secondary somatosensory cortex were associated with depression (q < 0.03), symptom related anxiety (q < 0.04), trait anxiety (q < 0.03), and symptom duration (q < 0.05).

CONCLUSION

A history of UC is associated with neuroplastic changes in several brain networks, which are associated with symptoms of depression, trait and symptom-related anxiety, as well as symptom duration. When viewed together with the results from IBS subjects, these findings suggest that chronic gut inflammation as well as abdominal pain have a lasting impact on brain network organization, which may play a role in symptoms reported by UC patients, even when gut inflammation has subsided.

Fatigue in irritable bowel syndrome is associated with plasma levels of TNF-α and mesocorticolimbic connectivity

Irritable bowel syndrome (IBS) is a symptom-based disorder of gut-brain interactions generating abdominal pain. It is also associated with a vulnerability to develop extraintestinal symptoms, with fatigue often reported as one of the most disturbing. Fatigue is related to brain function and inflammation in several disorders, however, the mechanisms of such relations in IBS remain elusive. This study aimed to elucidate fatigue and its association with a resting state network of mesocorticolimbic regions of known importance in fatigue, and to explore the possible role of circulating TNF-α levels in IBS and healthy controls (HC). Resting state functional magnetic resonance imaging (fMRI) was conducted in 88 IBS patients and 47 HC of similar age and gender to investigate functional connectivity between mesocorticolimbic regions. Further, fatigue impact on daily life and plasma levels of the proinflammatory cytokine tumor necrosis factor-α (TNF-α), of known relevance to immune activation in IBS, were also measured. The selected mesocorticolimbic regions indeed formed a functionally connected network in all participants. The nucleus accumbens (NAc), in particular, exhibited functional connectivity to all other regions of interest. In IBS, fatigue impact on daily life was negatively correlated with the connectivity between NAc and dorsolateral prefrontal cortex bilaterally (left p = 0.019; right p = 0.038, corrected for multiple comparisons), while in HC, fatigue impact on daily life was positively correlated to the connectivity between the right NAc and anterior middle insula in both hemispheres (left p = 0.009; right p = 0.011). We found significantly higher levels of TNF-α in IBS patients compared to HC (p = 0.001) as well as a positive correlation between TNF-α and fatigue impact on daily life in IBS patients (rho = 0.25, p = 0.02) but not in HC (rho = -0.13, p = 0.37). There was no association between functional connectivity in the mesocorticolimbic network and plasma levels of TNF-α in either group In summary, this novel multimodal study provides the first evidence that the vulnerability to fatigue in IBS is associated with connectivity within a mesocorticolimbic network as well as immune activation. These findings warrant further investigation, both peripherally and potentially with measurements of central immune activation as well.

Resting state functional connectivity of the pain matrix and default mode network in irritable bowel syndrome: a graph theoretical analysis

Irritable bowel syndrome (IBS) is a functional disorder of brain-gut interactions. Differential brain responses to rectal distention between IBS and healthy controls (HCs) have been demonstrated, particularly in the pain matrix and the default mode network. This study aims to compare resting-state functional properties of these networks between IBS patients and HCs using graph analysis in two independent cohorts. We used a weighted graph analysis of the adjacency matrix based on partial correlations between time series in the different regions in each subject to determine subject specific graph measures. These graph measures were normalized by values obtained in equivalent random networks. We did not find any significant differences between IBS patients and controls in global normalized graph measures, hubs, or modularity structure of the pain matrix and the DMN in any of our two independent cohorts. Furthermore, we did not find consistent associations between these global network measures and IBS symptom severity or GI-specific anxiety but we found a significant difference in the relationship between measures of psychological distress (anxiety and/or depressive symptoms) and normalized characteristic path length. The responses of these networks to visceral stimulation rather than their organisation at rest may be primarily disturbed in IBS.

Convergent syndromic atrophy of pain and emotional systems in patients with irritable bowel syndrome and depressive symptoms

Irritable bowel syndrome (IBS) is a brain-gut disorder that is often accompanied by psychiatric comorbidities, particularly depression. However, the neuroanatomical substrates of IBS with depressive symptoms (DEP-IBS) and how depressive symptoms and brain morphology modulate IBS symptoms remain unknown. In this study, structural MRI data were processed using a voxel-based morphometry technique and one-way analysis of covariance (ANCOVA) and post-hoc t-tests were performed to compare gray matter volume (GMV) among 28 patients with DEP-IBS, 21 patients with IBS who lacked depressive symptoms (nDEP-IBS), and 36 healthy controls (HC). Correlation and mediation analyses were performed to evaluate the relationship between differing GMV in DEP-IBS and clinical variables. We found that GMV in the bilateral prefrontal, insular, and dorsal striatal areas, as well as the left temporal pole, were significantly lower in the DEP-IBS group than in the HC group. Moreover, compared with the nDEP-IBS group, the DEP-IBS group exhibited decreased GMV in the bilateral medial, dorsolateral prefrontal, and orbitofrontal cortices, bilateral dorsal striatum, and left insular cortices. Correlation analysis revealed that GMV in these atrophic brain areas of the DEP-IBS group was negatively correlated with depression, gastrointestinal symptoms, and disease duration. Our results further revealed that depressive symptoms served as a mediator between gastrointestinal symptoms and GMV in the left insula, right medial prefrontal cortex, and right middle frontal gyrus, while gastrointestinal symptoms served as a mediator between depression and GMV in these regions. Our results suggest convergent syndromic atrophy in the pain and emotional systems of patients with DEP-IBS.

Imaging Inflammation and Infection in the Gastrointestinal Tract

A variety of seemingly non-specific symptoms manifest within the gastrointestinal (GI) tract, particularly in the colon, in response to inflammation, infection, or a combination thereof. Differentiation between symptom sources can often be achieved using various radiologic studies. Although it is not possible to provide a comprehensive survey of imaging gastrointestinal GI tract infections in a single article, the purpose of this review is to survey several topics on imaging of GI tract inflammation and infections. The review discusses such modalities as computed tomography, positron emission tomography, ultrasound, endoscopy, and magnetic resonance imaging while looking at up-an-coming technologies that could improve diagnoses and patient comfort. The discussion is accomplished through examining a combination of organ-based and organism-based approaches, with accompanying selected case examples. Specific focus is placed on the bacterial infections caused by Shigella spp., Escherichia coli, Clostridium difficile, Salmonella, and inflammatory conditions of diverticulitis and irritable bowel disease. These infectious and inflammatory diseases and their detection via molecular imaging will be compared including the appropriate differential diagnostic considerations.

Elucidating the putative link between prefrontal neurotransmission, functional connectivity, and affective symptoms in irritable bowel syndrome

Altered neural mechanisms are well-acknowledged in irritable bowel syndrome (IBS), a disorder of brain-gut-communication highly comorbid with anxiety and depression. As a key hub in corticolimbic inhibition, medial prefrontal cortex (mPFC) may be involved in disturbed emotion regulation in IBS. However, aberrant mPFC excitatory and inhibitory neurotransmission potentially contributing to psychological symptoms in IBS remains unknown. Using quantitative magnetic resonance spectroscopy (qMRS), we compared mPFC glutamate + glutamine (Glx) and γ-aminobutyric acid (GABA+) concentrations in 64 women with IBS and 32 age-matched healthy women (HCs) and investigated their association with anxiety and depression in correlational and subgroup analyses. Applying functional magnetic resonance imaging (fMRI), we explored whether altered neurotransmission was paralleled by aberrant mPFC resting-state functional connectivity (FC). IBS patients did not differ from HCs with respect to mPFC GABA+ or Glx levels. Anxiety was positively associated with mPFC GABA+ concentrations in IBS, whereas Glx was unrelated to psychological or gastrointestinal symptoms. Subgroup comparisons of patients with high or low anxiety symptom severity and HCs revealed increased GABA+ in patients with high symptom severity, and lower mPFC FC with adjacent anterior cingulate cortex (ACC), a crucial region of emotion modulation. Our findings provide novel evidence that altered prefrontal inhibitory neurotransmission may be linked to anxiety in IBS.

Efficacy of noninvasive evaluations in monitoring inflammatory bowel disease activity: A prospective study in China

AIM

To optimize the efficacy of noninvasive evaluations in monitoring the endoscopic activity of inflammatory bowel disease (IBD).

METHODS

Fecal calprotectin (FC), clinical activity index (CDAI or CAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin (PCT) were measured for 136 IBD patients. Also, FC was measured in 25 irritable bowel syndrome (IBS) patients that served as controls. Then, endoscopic activity was determined by other two endoscopists for colonic or ileo-colonic Crohn’s disease (CICD) with the “simple endoscopic score for Crohn’s disease” (SES-CD), CD-related surgery patients with the Rutgeerts score, and ulcerative colitis (UC) with the Mayo score. The efficacies of these evaluations to predict the endoscopic disease activity were assessed by Mann-Whitney test, χ² test, Spearman’s correlation, and multiple linear regression analysis.

RESULTS

The median FC levels in CD, UC, and IBS patients were 449.6 (IQR, 137.9-1344.8), 497.9 (IQR, 131.7-118.0), and 9.9 (IQR, 049.7) μg/g, respectively (P < 0.001). For FC, CDAI or CAI, CRP, and ESR differed significantly between endoscopic active and remission in CICD and UC patients, but not in CD-related surgery patients. The SES-CD correlated closely with levels of FC (r = 0.802), followed by CDAI (r = 0.734), CRP (r = 0.658), and ESR (r = 0.557). The Mayo score also correlated significantly with FC (r = 0.837), CAI (r = 0.776), ESR (r = 0.644), and CRP (r = 0.634). For FC, a cut-off value of 250 μg/g indicated endoscopic active inflammation with accuracies of 87.5%, 60%, and 91.1%, respectively, for CICD, CD-related surgery, and UC patients. Moreover, clinical FC activity (CFA) calculated as 0.8 × FC + 4.6 × CDAI showed higher area under the curve (AUC) of 0.962 for CICD and CFA calculated as 0.2 × FC + 50 × CAI showed higher AUC (0.980) for UC patients than the FC. Also, the diagnostic accuracy of FC in identifying patients with mucosal inflammation in clinical remission was reflected by an AUC of 0.91 for CICD and 0.96 for UC patients.

CONCLUSION

FC is the most promising noninvasive evaluation for monitoring the endoscopic activity of CICD and UC. CFA might be more accurate for IBD activity evaluation.

Negative correlation of cortical thickness with the severity and duration of abdominal pain in Asian women with irritable bowel syndrome

Background & aims

Irritable bowel syndrome (IBS) manifests as chronic abdominal pain. One pathophysiological theory states that the brain–gut axis is responsible for pain control in the intestine. Although several studies have discussed the structural changes in the brain of IBS patients, most of these studies have been conducted in Western populations. Different cultures and sexes experience different pain sensations and have different pain responses. Accordingly, we aimed to identify the specific changes in the cortical thickness of Asian women with IBS and to compare these data to those of non-Asian women with IBS.

Methods

Thirty Asian female IBS patients (IBS group) and 39 healthy individuals (control group) were included in this study. Brain structural magnetic resonance imaging was performed. We used FreeSurfer to analyze the differences in the cortical thickness and their correlations with patient characteristics.

Results

The left cuneus, left rostral middle frontal cortex, left supramarginal cortex, right caudal anterior cingulate cortex, and bilateral insula exhibited cortical thinning in the IBS group compared with those in the controls. Furthermore, the brain cortical thickness correlated negatively the severity as well as duration of abdominal pain.

Conclusions

Some of our findings differ from those of Western studies. In our study, all of the significant brain regions in the IBS group exhibited cortical thinning compared with those in the controls. The differences in cortical thickness between the IBS patients and controls may provide useful information to facilitate regulating abdominal pain in IBS patients. These findings offer insights into the association of different cultures and sexes with differences in cortical thinning in patients with IBS.

Differences in gut microbial composition correlate with regional brain volumes in irritable bowel syndrome

BACKGROUND

Preclinical and clinical evidence supports the concept of bidirectional brain-gut microbiome interactions. We aimed to determine if subgroups of irritable bowel syndrome (IBS) subjects can be identified based on differences in gut microbial composition, and if there are correlations between gut microbial measures and structural brain signatures in IBS.

METHODS

Behavioral measures, stool samples, and structural brain images were collected from 29 adult IBS and 23 healthy control subjects (HCs). 16S ribosomal RNA (rRNA) gene sequencing was used to profile stool microbial communities, and various multivariate analysis approaches were used to quantitate microbial composition, abundance, and diversity. The metagenomic content of samples was inferred from 16S rRNA gene sequence data using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt). T1-weighted brain images were acquired on a Siemens Allegra 3T scanner, and morphological measures were computed for 165 brain regions.

RESULTS

Using unweighted Unifrac distances with hierarchical clustering on microbial data, samples were clustered into two IBS subgroups within the IBS population (IBS1 (n = 13) and HC-like IBS (n = 16)) and HCs (n = 23) (AUROC = 0.96, sensitivity 0.95, specificity 0.67). A Random Forest classifier provided further support for the differentiation of IBS1 and HC groups. Microbes belonging to the genera Faecalibacterium, Blautia, and Bacteroides contributed to this subclassification. Clinical features distinguishing the groups included a history of early life trauma and duration of symptoms (greater in IBS1), but not self-reported bowel habits, anxiety, depression, or medication use. Gut microbial composition correlated with structural measures of brain regions including sensory- and salience-related regions, and with a history of early life trauma.

CONCLUSIONS

The results confirm previous reports of gut microbiome-based IBS subgroups and identify for the first time brain structural alterations associated with these subgroups. They provide preliminary evidence for the involvement of specific microbes and their predicted metabolites in these correlations.

Brain white matter changes associated with urological chronic pelvic pain syndrome: multisite neuroimaging from a MAPP case-control study

Clinical phenotyping of urological chronic pelvic pain syndromes (UCPPSs) in men and women have focused on end organ abnormalities to identify putative clinical subtypes. Initial evidence of abnormal brain function and structure in male pelvic pain has necessitated large-scale, multisite investigations into potential UCPPS brain biomarkers. We present the first evidence of regional white matter (axonal) abnormalities in men and women with UCPPS, compared with positive (irritable bowel syndrome, IBS) and healthy controls. Epidemiological and neuroimaging data were collected from participants with UCPPS (n = 52), IBS (n = 39), and healthy sex- and age-matched controls (n = 61). White matter microstructure, measured as fractional anisotropy (FA), was examined by diffusion tensor imaging. Group differences in regional FA positively correlated with pain severity, including segments of the right corticospinal tract and right anterior thalamic radiation. Increased corticospinal FA was specific and sensitive to UCPPS, positively correlated with pain severity, and reflected sensory (not affective) features of pain. Reduced anterior thalamic radiation FA distinguished patients with IBS from those with UCPPS and controls, suggesting greater microstructural divergence from normal tract organization. Findings confirm that regional white matter abnormalities characterize UCPPS and can distinguish between visceral diagnoses, suggesting that regional axonal microstructure is either altered with ongoing pain or predisposes its development.

Irritable bowel syndrome evaluation using computed tomography colonography

AIM

To evaluate the morphology of the colon in patients with irritable bowel syndrome (IBS) by using computed tomography colonography (CTC).

METHODS

Twelve patients with diarrhea type IBS (IBS-D), 13 patients with constipation type IBS (IBS-C), 12 patients with functional constipation (FC) and 14 control patients underwent colonoscopy following CTC. The lengths of the rectosigmoid colon, transverse colon and the total colon were measured. The diameters of the rectum, sigmoid colon, descending colon, transverse colon, and ascending colon were measured.

RESULTS

The mean length of the total colon was 156.5 cm in group C, 158.9 cm in group IBS-D, 172.0 cm in group IBS-C, and 188.8 cm in group FC. The total colon in group FC was significantly longer than that in group C (P < 0.05). The mean length of the rectosigmoid colon was 56.2 cm, 55.9 cm, 63.6cm, and 77.4 cm (NS). The mean length of the transverse colon was 49.9 cm, 43.1 cm, 57.0 cm, and 55.0 cm. The transverse colon in group IBS-D was significantly shorter than that in group IBS-C (P < 0.01) and that in group FC (P = 0.02). The mean diameter of the sigmoid colon was 4.0 cm, 3.3 cm, 4.2 cm, and 4.3 cm (NS). The mean diameter of the descending colon was 3.6 cm, 3.1 cm, 3.8 cm, and 4.3 cm. The descending colon diameter in group IBS-D was significantly less than that in group IBS-C (P = 0.03) and that in group FC (P < 0.001). The descending colon diameter in group FC was significantly greater than that in group C (P = 0.04). The mean diameter of the transverse colon was 4.4 cm, 3.3 cm, 4.2 cm, and 5.0 cm (NS).

CONCLUSION

CT colonography might contribute the clarification of subtypes of IBS.

Grading of Crohn's disease activity using CT, MRI, US and scintigraphy: a meta-analysis

PURPOSE

To assess the grading of Crohn's disease activity using CT, MRI, US and scintigraphy.

MATERIALS AND METHODS

MEDLINE, EMBASE and Cochrane databases were searched (January 1983-March 2014) for studies evaluating CT, MRI, US and scintigraphy in grading Crohn's disease activity compared to endoscopy, biopsies or intraoperative findings. Two independent reviewers assessed the data. Three-by-three tables (none, mild, frank disease) were constructed for all studies, and estimates of accurate, over- and under-grading were calculated/summarized by fixed or random effects models.

RESULTS

Our search yielded 9356 articles, 19 of which were included. Per-patient data showed accurate grading values for CT, MRI, US and scintigraphy of 86% (95% CI: 75-93%), 84% (95% CI: 67-93%), 44% (95% CI: 28-61%) and 40% (95% CI: 16-70%), respectively. In the per-patient analysis, CT and MRI showed similar accurate grading estimates (P = 0.8). Per-segment data showed accurate grading values for CT and scintigraphy of 87% (95% CI: 77-93%) and 86% (95% CI: 80-91%), respectively. MRI and US showed grading accuracies of 67-82% and 56-75%, respectively.

CONCLUSIONS

CT and MRI showed comparable high accurate grading estimates in the per-patient analysis. Results for US and scintigraphy were inconsistent, and limited data were available.

KEY POINTS

• CT and MRI have comparable high accuracy in grading Crohn's disease. • Data on US and scintigraphy is inconsistent and limited. • MRI is preferable over CT as it lacks ionizing radiation exposure.

[Diagnostic strategy in patients suspected of irritable bowel syndrome]

Irritable bowel syndrome, a very common condition with a high use of health-care costs especially related to diagnostic testing, is traditionally approached by a diagnostic strategy of exclusion. However, data from clinical studies support a positive diagnostic strategy based on symptom-based criteria, absence of alarm signals and, if needed, a few simple blood tests in young patients presenting in primary care. For older patients, and for patients not fulfilling symptom-based criteria or presenting with alarm signals, more thorough investigations are needed, directed by the symptomatology.

[Gallbladder contractility in children with functional abdominal pain or irritable bowel syndrome]

III Rome Criteria of functional gastrointestinal disorders in children, distinguished the disturbances with abdominal pain, to which irritable bowel syndrome, functional abdominal pains, functional dyspepsia and abdominal migraine were included. THE AIM OF THE STUDY was sonographic assessment of the gallbladder and its contractility in functional abdominal pain and irritable bowel syndrome in children.

MATERIAL AND METHODS

The study comprised 96 children aged 6 to 18 years, 59 girls and 37 boys. Depending on diagnosis, the children were divided into three groups. 38 children with functional abdominal pain constituted the first group, 26 children with irritable bowel syndrome were included to the second group, the third group consisted of 32 healthy children (control group). Diagnosis of functional abdominal pain and irritable bowel syndrome was made based on the III Rome Criteria. In irritable bowel syndrome both forms with diarrhea (13) and with constipation (13) were observed. Anatomy and contractility of the gallbladder were assessed by ultrasound examination. The presence of septum, wall thickness, thick bile, vesicle volume in fasting state and 30th and 60th minute after test meal were taken into consideration. Test meal comprised about 15% of caloric requirement of moderate metabolism. Children with bile stones and organic diseases were excluded from the study.

RESULTS

Thickened vesicle wall and thick bile were present more frequently in children with irritable bowel syndrome and functional abdominal pain than in control group (p < 0.02). Fasting vesicle volume was significantly greater in children with functional abdominal pain than in irritable bowel syndrome and control group (p = 0.003, p = 0.05). Vesicle contractility after test meal was greatest in children with functional abdominal pain. Evaluation of diminished (smaller than 30%) and enlarged (greater then 80%) gallbladder contractility at 30th and 60th minute after test meal demonstrated disturbances of contractility in children with irritable bowel syndrome and functional abdominal pain.

CONCLUSIONS

In children with functional abdominal pain and irritable bowel syndrome disturbances of gallbladder anatomy, fasting volume and contractility after test meal were demonstrated. The observed disturbances require further studies for explanation of their role in functional gastrointestinal disturbances with abdominal pain in children.

Crohn's disease activity assessed by Doppler sonography: the role of aortic flow parameters

OBJECTIVES

Intestinal neovascularization and abnormal abdominal arterial flow rates have been reported in Crohn's disease. The aim of this study was to evaluate Doppler sonography as a method for assessing Crohn's disease activity based on changes in splanchnic hemodynamics.

METHODS

Forty-eight patients with Crohn's disease, 22 healthy volunteers and 12 patients with irritable bowel syndrome were evaluated by Doppler ultrasound for flow parameters of the aorta and superior mesenteric artery. This evaluation included the cross-sectional area, maximum flow volume, peak systolic velocity, end diastolic velocity, resistance and the pulsatility index. Disease activity was classified according to the Crohn's disease activity index.

RESULTS

Most measurements in the aorta and superior mesenteric artery were significantly different between Crohn's disease patients and both control groups. Only the aortic maximum flow volume (CC = 0.37, p = 0.009) and aortic peak systolic velocity (CC = 0.30, p = 0.035) showed a significant positive correlation with the Crohn's disease activity index. The determination of cut-off points for the aortic maximum flow volume and peak systolic velocity measurements increased the sensitivity (80 and 75% for flow volume and velocity, respectively), specificity (57 and 75%), accuracy (67 and 75%) and positive (57 and 68%) and negative (80 and 81%) predictive values. These cut-off values permitted the correct classification of most of the patients with Crohn's disease with respect to disease activity. None of the superior mesenteric artery measurements were able to discriminate patients in relation to disease activity.

CONCLUSION

The aortic maximum flow volume and peak systolic velocity levels estimated by Doppler sonography reflected disease activity in Crohn's disease. Doppler sonography of the aorta is therefore a novel noninvasive adjunct method that may be useful in the clinical follow-up of patients with Crohn's disease.

Acromegaly is not associated with irritable bowel syndrome: a pilot study

BACKGROUND

In acromegaly, the gastrointestinal system is under the influence of excessive growth hormone (GH) and insulin like growth factor-1 (IGF-I). Increased bowel length and delayed transit time may cause functional disturbance of the bowel. The objective of the current study is to evaluate the frequency of irritable bowel syndrome (IBS) in cases with acromegaly.

PATIENTS AND METHODS

Twenty-three active cases with acromegaly newly diagnosed between 2010-2011 were included in the study. The control group consisted of ninety gender and age-matched healthy controls (HC). All cases were questioned for presence of IBS using Rome III criteria. Abdominal ultrasonography and colonoscopy results of acromegalic patients were obtained. In addition, cases with acromegaly were evaluated for their quality of life and status of depression by using the Acromegaly Quality of Life Questionnaire (AcroQoL) and Beck Depression Inventory (BDI), respectively.

RESULTS

The median GH and IGF-1 levels of cases with acromegaly were 5.72 [IQR: 2.2-34] ng/ml and 753 [IQR: 503-1050] ng/ml, respectively. The median AcroQoL score of patients with acromegaly was 56 [IQR: 43-71.5] and the median BDI score was 16 [IQR: 11-21]. Rome III diagnostic criteria were positive in 2 of 23 acromegaly patients and in 3 of 90 HC (p=0.26). IBS was present in 1 of 23 of the acromegaly patients compared to 3 of 90 HC (p=0.81).

CONCLUSION

Although acromegaly and IBS may cause similar gastrointestinal symptoms, acromegaly is not associated with a greater incidence of true IBS.

Evidence for alterations in central noradrenergic signaling in irritable bowel syndrome

BACKGROUND/AIMS

Alterations in noradrenergic (NE) signaling have been implicated in the pathophysiology of irritable bowel syndrome (IBS), and adrenergic receptors are potential treatment targets.

METHODS

To characterize central NE signaling in IBS, 11 patients and 11 healthy controls (HCs) were studied 3 times during an auditory oddball vigilance task after double-blind ingestion of the α2-adrenoreceptor (α2AR) antagonist yohimbine (YOH), the α2AR agonist clonidine (CLO), or placebo (PLA). Regional cerebral glucose metabolism was measured with [¹⁸F] fluorodeoxyglucose (FDG) positron emission tomography (PET). Measures of anxiety, early-life trauma, plasma NE and blood pressure were acquired.

RESULTS

Patients had higher plasma NE levels than HCs before and after ingestion of all drugs (all p<0.05). YOH increased plasma NE and more anxiety in patients than in HCs. After YOH, NE levels directly correlated with drug-induced increases in anxiety in IBS patients (r=0.61), but not in HCs. IBS patients showed less YOH-mediated reduction of activity in a central arousal circuit, consistent with fewer functional presynaptic α2AR. In HCs, but not in patients, activation of amygdala and subgenual anterior cingulate cortex (sgACC) was inversely correlated with activation of anterior mid cingulate cortex (aMCC), and state anxiety covaried directly with activity in limbic and right frontotemporal cortices, but indirectly with activity in the left frontotemporal cortex. YOH-mediated reduction of activity in brainstem and amygdala inversely correlated with early life trauma.

CONCLUSIONS

IBS patients showed evidence for increased noradrenergic activity consistent with downregulation of presynaptic inhibitory α2ARs. Activity within central arousal circuits was biased toward greater excitability and reduced corticolimbic inhibition in IBS. Early life trauma may be one mediator of these abnormalities.

Constipation-predominant irritable bowel syndrome complicating asymptomatic nonrotation of the midgut

Nonrotation is a part of the spectrum of anatomic anomalies comprising malrotation. Most cases of nonrotation are symptomatic and managed surgically with a Ladd's procedure. However, incidental discovery of asymptomatic patients has also been reported. In these cases, the role of surgery is debated. The authors describe a case of nonrotation in a young woman with constipation-predominant irritable bowel syndrome that caused symptoms associated with nonrotation. Medical management of her irritable bowel syndrome resulted in the resolution of all abdominal complaints and a Ladd's procedure was not recommended. The authors include a literature review of nonrotation with an emphasis on the treatment of asymptomatic disease.

First signs and symptoms of spondyloarthritis--data from an inception cohort with a disease course of two years or less (REGISPONSER-Early)

OBJECTIVE

To determine the first signs and symptoms, and the clinical, biological and radiological characteristics of patients with early SpA.

METHODS

A total of 150 SpA patients were selected from 2367 listed in REGISPONSER (Registro Español de Espondiloartritis de la Sociedad Española de Reumatología). The inclusion criterion was a disease course of

RESULTS

Forty-six patients had AS, 51 psoriatic SpA (Ps-SpA), 43 uSpA, 5 ReA, 4 IBD arthropathy and 1 JCA. The mean age at onset of symptoms and at diagnosis was higher in Ps-SpA group (48.1 +/- 13.6 and 48.5 +/- 13.6 yrs) than in AS group (38.1 +/- 12.8 and 38.9 +/- 12.7 yrs) and uSpA group (36.3 +/- 11.5 and 36.9 +/- 11.4 yrs). The most frequent signs or symptoms were back pain: 72% AS group and 56% uSpA group. Lower limb arthritis was the first symptom in 57% Ps-SpA patients, 35% uSpA patients and 20% AS patients; upper limb arthritis was the first symptom in 53% Ps-SpA group and <16% of the remainder. Compared with longer duration disease, at onset, AS patients report upper limb arthritis more frequently and uSpA patients report more of enthesitis. Early radiological sacroiliitis was observed in all AS patients, of whom 54% had Grade II, 39% had Grade III and 7% had Grade IV.

CONCLUSIONS

In our population, the first manifestations of SpA were low back pain and SI syndrome in AS and uSpA patients and peripheral arthritis in the Ps-SpA group. We can find early SI joint affectation in AS patients.

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Key Words

• spas
• as
• uspa
• spa's cohort
• epidemiology
• disease registry

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MESH Headings

• Adult
• Age of Onset
• Analysis of Variance
• Arthritis/diagnosis
• Arthritis/diagnostic imaging
• Arthritis, Psoriatic/diagnosis
• Arthritis, Psoriatic/diagnostic imaging
• Back Pain/diagnosis
• Back Pain/diagnostic imaging
• Cohort Studies
• Female
• Humans
• Irritable Bowel Syndrome/diagnosis
• Irritable Bowel Syndrome/diagnostic imaging
• Male
• Middle Aged
• Prohibitins
• Radiography
• Sacroiliac Joint/diagnostic imaging
• Spondylarthritis/diagnosis
• Spondylarthritis/diagnostic imaging
• Spondylitis, Ankylosing/diagnosis
• Spondylitis, Ankylosing/diagnostic imaging

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Affiliation(s)

Marena Rojas-Vargas Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Elisa Muñoz-Gomariz Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Alejandro Escudero Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Pilar Font Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Pedro Zarco Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Raquel Almodovar Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Jordi Gratacós Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Juan Mulero Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Xavier Juanola Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Carlos Montilla Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Estefanía Moreno Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Eduardo Collantes-Estevez Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
on behalf of REGISPONSER working group

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A survey about irritable bowel syndrome in South Korea: prevalence and observable organic abnormalities in IBS patients

The aims of the present study were: (1) to assess the prevalence of symptom-based irritable bowel syndrome (IBS) in Korean adults, (2) to assess several organic abnormalities which can be found in IBS patients, and (3) to analyze the risk or associated factors that influence the presence of IBS. Adult health examinees were requested to fill out a questionnaire. The prevalence of IBS was calculated using Rome II criteria. Using several tests, several organic abnormalities were identified in the IBS group. Risk factors were analyzed by comparing the IBS and normal groups. The prevalence value for IBS according to Rome II criteria was 16.8%. Mucosal hyperplasia, lymphocyte aggregation, and increased eosinophil counts were relatively common microscopic findings in IBS group. Female gender, self-consciousness of IBS, and irregular defecation were expressed as significantly independent risk or associated factors for IBS. Several colonic microscopic findings mentioned above may be helpful in accurate diagnosis of IBS. Therefore a more-precise and large population study about these findings is necessary to reach a definitive conclusion.

Does co-administration of a non-selective opiate antagonist enhance acceleration of transit by a 5-HT4 agonist in constipation-predominant irritable bowel syndrome? A randomized controlled trial

Opioid neurons exhibit tonic restraint on intestinal motility; opioid antagonists stimulate peristalsis and increase transit. In vitro, 5-hydroxytryptamine (5-HT4) agonists combined with selective opioid antagonists significantly increased colonic propulsion relative to a 5-HT4 agonist alone. We hypothesized that the combination of 5-HT4 agonist and non-selective opioid antagonist enhances intestinal transit more than either treatment alone in female constipation-predominant irritable bowel syndrome (C-IBS) patients. Our aim was to examine the effect of tegaserod 6 mg b.i.d. alone and combined with naltrexone 50 mg on intestinal transit and stool characteristics in females with C-IBS. Forty-eight patients were randomized to tegaserod alone, naltrexone alone or in combination with tegaserod or placebo for 6 days. Small bowel, ascending colon half-life (in pharmacokinetics) (t1/2), and colonic geometric centre (8, 24, 48 h) were assessed by scintigraphy. Tegaserod increased small bowel (P < 0.01) and colon transit (P < 0.01). Naltrexone did not accelerate colonic transit relative to placebo. Combination treatment did not significantly accelerate transit relative to tegaserod alone. Tegaserod and tegaserod with naltrexone resulted in looser stool form (P < 0.01). In female C-IBS patients, tegaserod accelerates small bowel and colon transit and contributed to looser stool consistency. Use of naltrexone, 50 mg, does not support the hypothesis that combination of 5-HT4 agonist and non-selective opioid antagonist enhances intestinal transit.

Intestinal gas in plain abdominal radiographs does not correlate with symptoms after lactulose challenge

OBSERVATION

Intestinal gas production and abdominal discomfort can be triggered by the ingestion of carbohydrates such as lactulose. Using plain abdominal radiographs, we studied whether subjective complaints after a lactulose breath test would be quantitatively related to intestinal gas volumes.

METHODS

Abdominal symptoms after the breath test were quantified by a written questionnaire and gas volumes were scored in plain abdominal radiographs, in 50 consecutive patients with unexplained, irritable bowel syndrome-like symptoms. Breath excretion of hydrogen and methane was determined in all patients.

RESULTS

Forty-two (84%) of the patients claimed that their post-breath test symptoms were a true replicate of their customary discomfort. Total symptom scores (sum of scores for pain/discomfort, borborygmi, bloating, diarrhea, constipation) or any specific symptom score were not significantly correlated to gas volume scores (r=-0.04; P=0.8 for total symptom score). The 13 (26%) methane producers had significantly higher mean gas volume scores compared with nonproducers (0.38 vs. 0.24; P=0.0008), but fewer symptoms (total symptom score 11.9 vs. 18.2; P=0.17).

CONCLUSION

Intestinal gas volume, as scored in plain abdominal radiographs, is not correlated with abdominal discomfort after lactulose challenge. Intestinal gas may not be the major cause of abdominal discomfort following carbohydrate ingestion in patients with functional gut disorders.

Prevalence of lower extremity venous disease in inflammatory bowel disease

AIM

Inflammatory bowel disease (IBD) has long been considered a risk factor for venous thromboembolism (VTE). Whereas most patients have persistent venous valvular dysfunction following lower extremity deep venous thrombosis (DVT), we hypothesized that patients with IBD would have an increased prevalence of valvular incompetence and changes of chronic DVT (reduced venous caliber with thickened walls) relative to patients with irritable bowel syndrome (IBS) or normal volunteers.

METHODS

Subjects with confirmed IBD, clinical features of IBS or normal volunteers underwent complete, prospective duplex ultrasound assessment of their lower extremity venous vascular system. The sonographer performing the venous study was blinded to the clinical diagnosis of the patients. Valvular incompetence was graded as mild, moderate or severe based on accepted criteria.

RESULTS

Eighty patients with IBD (ulcerative colitis, UC: 66; Crohn's disease: 14), 80 patients with IBS, and 80 healthy volunteers agreed to participate. One patient with UC was found to have non-occlusive chronic DVT within the left superficial femoral vein. Mild and moderate valvular incompetence was evenly distributed between the 3 groups. No patients met criteria for either acute DVT or severe venous incompetence.

CONCLUSION

In patients with IBD, neither valvular incompetence nor chronic venous obstruction are over-represented compared to patients with IBS or normal volunteers. In this prospective assessment of venous physiology by duplex ultrasound, we were not able to confirm prior reports that IBD is a major risk factor for VTE.

Bowel urgency in patients with irritable bowel syndrome

BACKGROUND & AIMS

Bowel urgency is the most bothersome symptom in irritable bowel syndrome patients with diarrhea, but its pathophysiology is poorly understood. Our aim was to assess the relationships among reporting the symptom, the reservoir functions of the colon and rectum, and the patients' psychologic profile.

METHODS

The study involved 28 consecutive patients with irritable bowel syndrome and 17 healthy subjects. The presence or absence of bowel urgency was verified by means of a questionnaire during the 3 days required for the ingestion of radio-opaque markers. On the fourth day, an abdominal x-ray was taken to assess colonic transit time, and rectal sensory and motor responses were measured during rectal distention. The subjects' psychologic profiles were assessed using a psychologic symptoms checklist.

RESULTS

Forty-six percent of the patients reported urgency associated with at least 1 defecation. The multivariate logistic regression analysis showed that colonic transit was the only variable independently associated with reported bowel urgency, but the threshold for the sensation of urgency was not removed from the model since its borderline significance level. Rectal compliance was closely associated with the threshold for the sensation of urgency during rectal distention but was not an independent factor for reporting the sensation. The patients with and without urgency showed altered psychologic profiles.

CONCLUSIONS

The symptom of urgency is associated with objective alterations in the colonic and rectal reservoir of patients with irritable bowel syndrome.

[Ultrasonographic assessment of sigmoid colon in patients with irritable bowel syndrome]

Although the pathophysiological factors may play a role in the pathogenesis of irritable bowel syndrome (IBS), the function of sigmoid colon has been reported as a major pathogenesis of IBS. Our objective was to evaluate motility patterns of sigmoid colon by using ultrasonography(US) in patients with IBS compared to healthy volunteers (HV). SUBIECTS AND METHODS: <Fasting phase> US examination of sigmoid colon was performed in 69 patients with IBS and 69 HV with 3.75 MHz curved array scanner and 7.5 MHz linear array scanner. The US probe was positioned longitudinally to permit simultaneous visualization of sigmoid colon crossing over the iliopsoas. We classified 3 types of fasting sigmoid colon, spastic type, empty type, and normal type, according to the US findings. <Postprandial phase> Four IBS patients with diarrhea, 4 with constipation and 4 HV were given the liquid test meal (200ml, 400kcal). The frequency of segmental contractions (contractions without propagation) and propulsion were evaluated by US in the same fashion for 30 minutes before and for 60 minutes after investigation.

RESULTS

<Fasting phase> Sixty-two percent of IBS showed spastic type and 65% of HV showed normal type. IBS patients accounted for 80 % of spastic type (IBS vs spastic type of US findings: Sensitivity 62%, Specificity 91%). <Postprandial phase> The changes of frequency of segmental contractions were smaller in IBS patients with constipation. The changes of frequency of propulsion were larger in IBS patients with diarrhea.

CONCLUSION

Ultrasonographic assessment of sigmoid colon may provide a better understanding of the pathogenesis of IBS.

Ultrasonographic evaluation of gallbladder functions in patients with irritable bowel syndrome

BACKGROUND

The aim of the present study was to evaluate gallbladder function in irritable bowel syndrome (IBS) patients.

METHODS

The functions of gallbladder were investigated every 30 min for 4 h. In addition, ejection fraction of the gallbladder was calculated from the fasting and post-prandial volumes.

RESULTS

In IBS patients and healthy controls, fasting gallbladder volumes were 19.64 +/- 3.09 mL and 20.04 +/- 1.82 mL, and residual volumes after 3 h were 3.36 +/- 6.82 mL and 9.74 +/- 1.50 mL. Except for the residual volume after 3 h, all these results were not statistically significant. Residual volume after 3 h was statistically significantly lower in the IBS patients than in the controls (P < 0.001). Ejection fraction of the gallbladder was significantly higher in the IBS patients than in the controls (84% vs 55%, P < 0.001).

CONCLUSIONS

Gallbladder contraction in patients with IBS was not different from that of a control group at post-prandial second hour but was signigicantly more pronounced at the end of 3 h when compared with controls. Ejection fraction of the gallbladder was higher in IBS patients when compared with controls.

Longitudinal change in perceptual and brain activation response to visceral stimuli in irritable bowel syndrome patients

BACKGROUND & AIMS

Symptom-related fears and associated hypervigilance toward visceral stimuli may play a role in central pain amplification and irritable bowel syndrome (IBS) pathophysiology. Repeated stimulus exposure leads to decreased salience of threat and reduction of hypervigilance. We sought to evaluate hypervigilance in IBS visceral hypersensitivity and associated brain activity.

METHODS

Twenty IBS patients (14 female; moderate to severe symptoms) and 14 healthy controls participated in symptom and rectal distention assessments 6 times over 12 months. In a subset of 12 IBS patients, H2 15O-positron emission tomography images were obtained during baseline, rectal distentions, and anticipation of an aversive distention during the first and last session. Statistical parametric mapping (SPM99) was used to identify areas and networks activated during each session as well as those with differential activation across the 2 sessions.

RESULTS

Perceptual ratings of the rectal inflations normalized over 12 months, whereas IBS symptom severity did not. There were no sex-related differences in these response patterns. Stable activation of the central pain matrix was observed over 12 months, and activity in limbic, paralimbic, and pontine regions decreased. During the anticipation condition, there were significant decreases in amygdala, dorsal anterior cingulate cortex, and dorsal brainstem activation at 12 months. Covariance analysis supported the hypothesis of changes in an arousal network including limbic, pontine, and cortical areas underlying the decreased perception seen over the multiple stimulations.

CONCLUSIONS

In IBS patients, repeated exposure to experimental aversive visceral stimuli results in the habituation of visceral perception and central arousal, despite stable activation of networks processing visceral pain and its anticipation.

Ultrasound examination of the sigmoid colon: possible new diagnostic tool for irritable bowel syndrome

OBJECTIVE

Irritable bowel syndrome (IBS) affects about 10% of the population, and is primarily a disease of women. It may cause chronic pelvic pain. As yet there is no imaging test to aid in diagnosis, which relies upon history. We aimed to determine whether transvaginal sonographic investigation of the sigmoid colon could aid in the diagnosis of IBS.

METHOD

Transvaginal ultrasound was used in 175 female patients undergoing pelvic ultrasound studies for a variety of reasons, none specifically for bowel complaints. We measured the wall of the sigmoid colon and then obtained the history of positive or negative for IBS.

RESULTS

The majority of those 27 reporting a history of IBS had thickening of the wall of the sigmoid colon. A cut-off of 3.0 mm gave a sensitivity for this group of patients of 70%, specificity of 95%, positive predictive value of 73% and negative predictive value of 95%.

CONCLUSION

Transvaginal ultrasound may be useful in identifying patients at risk for IBS. Consideration of colon wall measurement during pelvic ultrasound should be studied, as IBS may be a cause of chronic pelvic pain.

Evaluation of gallbladder motility in patients with irritable bowel syndrome

BACKGROUND

Abnormalities involving smooth muscle function in different systems of the body have been reported in irritable bowel syndrome (IBS). There are a few studies on gallbladder function in this disorder with conflicting results.

OBJECTIVES

To investigate the motility of gallbladder in patients with IBS.

PATIENTS AND METHODS

Forty-eight patients (15 male and 33 female) with IBS and 48 healthy volunteers (15 male and 33 female) were included into the study. Thirty-four patients (70.8%) had constipation predominant and 14 patients (29.2%) had diarrhoea predominant type of IBS. Fasting and postprandial gallbladder volumes were studied using real time ultrasonography and ejection fraction (EF) of gallbladder was calculated.

RESULTS

While fasting gallbladder volume (FGV) was similar between IBS and control groups (18.0 +/- 4.0 ml vs. 17.8 +/- 4.9 ml, p >0.05), postprandial gallbladder volume (PGV) was lower in IBS group than in the control group (5.5 +/- 1.4 ml vs. 6.2 +/- 1.9 ml, p = 0.03). Accordingly, the mean EF of gallbladders was found to be higher in IBS group than in the control group (69.1% vs. 64.1%, p = 0.0001). There were no difference in FGV, PGV and EF of gallbladders between constipation predominant and diarrhoea predominant IBS patients (p >0.05).

CONCLUSION

The results of this study indicated that IBS patients have increased emptying of gallbladder compared to healthy subjects.

Are cardiac syndrome X, irritable bowel syndrome and reflex sympathetic dystrophy examples of lateral medullary ischaemic syndromes?

Altered pain appreciation and autonomic function are hallmarks of Cardiac syndrome X, Irritable bowel syndrome and Reflex sympathetic dystrophy. Both pain appreciation and autonomic function are controlled by the lateral medulla. This hypothesis proposes that lateral medullary ischaemia at a microvascular level is responsible for these syndromes and could also be linked to other conditions where autonomic dysfunction is a major feature such as late-onset asthma, type 2 diabetes and essential hypertension. Autonomic function is controlled by the nucleus tractus solitarius, which acts as the main viscero-afferent nucleus in the brain stem regulating vagal tone. It is particularly susceptible to ischaemia since it is highly metabolically active and lies in a medullary arterial watershed zone. The anatomical route of the vertebral artery through cervical vertebra makes it vulnerable to injury from whiplash with or without any genetic predisposition to atheroma formation. This could make microvascular occlusion commonplace and a plausible explanation for the above syndromes. Ischaemia rather than infarction occurs because of the excellent collateral blood supply in the brainstem. In support of this hypothesis, a new Transcranial doppler ultrasonography arterial signal has been described called small vessel knock, the ultrasound signal of small vessel occlusion. Recent evidence has shown that ultrasound targeting of this signal in the vertebral artery improves clinical symptoms in these syndromes which supports this hypothesis. Two such cases are discussed.

Technologies in the evaluation of irritable bowel syndrome

During a meeting in The Hague, The Netherlands, the IBiS Club evaluated the most important techniques that can be used in the investigation of irritable bowel syndrome, either in the context of scientific research or as a clinical diagnostic tool. In each of these, the relevance of findings made in irritable bowel syndrome was balanced against the applicability of the technique. The discussion of the group is summarized in this paper.

Nuclear medicine and infection detection: the relative effectiveness of imaging with 111In-oxine-, 99mTc-HMPAO-, and 99mTc-stannous fluoride colloid-labeled leukocytes and with 67Ga-citrate

With a current annual mortality rate of around 35% worldwide, infection remains a significant concern, and the diagnosis and localization of infectious foci is an important health issue. As an established infection-imaging modality, nuclear medicine plays a vital health-care role in the diagnosis and subsequent effective treatment of this condition. Despite the development of several newer radiopharmaceuticals, (67)Ga and leukocyte imaging procedures have maintained their established place for infection. Several techniques in nuclear medicine significantly aid infection diagnosis, including imaging with (111)In-oxine-, (99m)Tc-hexamethylpropyleneamine oxime-, and (99m)Tc-stannous fluoride colloid-labeled leukocytes and with (67)Ga-citrate. Each radiopharmaceutical has specific advantages and disadvantages that make it suitable to diagnose different infectious processes (e.g., soft-tissue sepsis, inflammatory bowel disease, osteomyelitis, occult fever, fever of unknown origin, and infections commonly found in immunocompromised patients). After finishing this article, the reader should be able to identify the properties of an ideal radiopharmaceutical for infection imaging, list a range of available infection-imaging radiopharmaceuticals, compare the relative results of a range of radiopharmaceuticals used internationally to detect infection in the body, understand several common infectious processes that can be diagnosed using nuclear medicine techniques, and select an appropriate radiopharmaceutical to image a range of infectious processes.