Irritable bowel syndrome in the general population.

OBJECTIVE--To determine the prevalence of symptoms compatible with a clinical diagnosis of irritable bowel syndrome in the general population. DESIGN--Validated postal questionnaire sent to 2280 subjects randomly selected in 10 year age bands from the lists of eight general practitioners. The Manning criteria were used to define irritable bowel syndrome. SETTING--Urban population in Southampton and mixed urban-rural population in Andover, Hampshire. RESULTS--A response of 71% yielded 1620 questionnaires for analysis, of which 412 (25%) reported more than six episodes of abdominal pain in the preceding year, with 350 (22%) reporting symptoms consistent with the diagnosis of irritable bowel syndrome. The male: female ratio was 1:1.38. More subjects with irritable bowel syndrome had constipation and diarrhoea and 35% with the syndrome reported rectal bleeding compared with an overall prevalence of 20%. Other symptoms and conditions including heartburn, dyspepsia, flushing, palpitations, migraine, and urinary symptoms were significantly more common in the group with irritable bowel syndrome. Abdominal pain in childhood was more common in the subjects with irritable bowel syndrome (12%) than without (3%). One third of the group with irritable bowel syndrome had sought medical advice during the study period (male:female ratio 1:1.21); consultation behaviour was influenced by age and the presence of associated symptoms, varied considerably among patients registered with different general practitioners, and was poorly correlated with symptom severity. CONCLUSION--Symptoms consistent with a diagnosis of irritable bowel syndrome are present in almost one quarter of the general population and tend to be associated with a number of other complaints and conditions, some of which may reflect smooth muscle dysfunction.     

微生态制剂丽珠肠乐治疗肠易激综合征

目的 :观察微生态制剂丽珠肠乐治疗肠易激综合征的疗效。方法 :门诊随机选择 4 2例肠易激综合征患者接受丽珠肠乐口服两周 ,观察患者多种症状如腹痛、腹胀、腹泻、便秘、腹泻便秘交替、黏液便、排便不尽感的变化。结果 :使用丽珠肠乐治疗后 ,患者上述症状有不同程度缓解 ,总有效率为 83 33%。双歧杆菌和乳酸杆菌显著升高 (P <0 0 1)。结论 :微生态制剂丽珠肠乐是治疗肠易激综合征的一种安全、有效的药物。     

Towards positive diagnosis of the irritable bowel.

A questionnaire to establish the presence of 15 symptoms thought to be typical of the irritable bowel syndrome (IBS) was given to 109 unselected patients referred to gastroenterology or surgery clinics with abdominal pain or a change in bowel habit or both. Review of case records 17--26 months later established a definite diagnosis of IBS in 32 patients and of organic disease in 33. Four symptoms were significantly more common among patients with IBS--namely, distension, relief of pain with bowel movement, and looser and more frequent bowel movements with the onset of pain. Mucus and a sensation of incomplete evacuation were also common in these patients. The more of these symptoms that were present the more likely was it that the patient''s pain or altered bowel habit, or both, was due to IBS. We conclude that a careful history can increase diagnostic confidence and reduce the amount of investigation in many patients with chronic abdominal pain.     

Pre-referral rectal artesunate in severe malaria: flawed trial

Introduction

Irritable bowel syndrome affects as many as 14% of high school-aged students. Symptoms include discomfort in the abdomen, along with diarrhea and/or constipation and other gastroenterological symptoms that can significantly impact quality of life and daily functioning. Emotional stress appears to exacerbate irritable bowel syndrome symptoms suggesting that mind-body interventions reducing arousal may prove beneficial. For many sufferers, symptoms can be traced to childhood and adolescence, making the early manifestation of irritable bowel syndrome important to understand. The current study will focus on young people aged 14-26 years with irritable bowel syndrome. The study will test the potential benefits of Iyengar yoga on clinical symptoms, psychospiritual functioning and visceral sensitivity. Yoga is thought to bring physical, psychological and spiritual benefits to practitioners and has been associated with reduced stress and pain. Through its focus on restoration and use of props, Iyengar yoga is especially designed to decrease arousal and promote psychospiritual resources in physically compromised individuals. An extensive and standardized teacher-training program support Iyengar yoga's reliability and safety. It is hypothesized that yoga will be feasible with less than 20% attrition; and the yoga group will demonstrate significantly improved outcomes compared to controls, with physiological and psychospiritual mechanisms contributing to improvements.

Methods/Design

Sixty irritable bowel syndrome patients aged 14-26 will be randomly assigned to a standardized 6-week twice weekly Iyengar yoga group-based program or a wait-list usual care control group. The groups will be compared on the primary clinical outcomes of irritable bowel syndrome symptoms, quality of life and global improvement at post-treatment and 2-month follow-up. Secondary outcomes will include visceral pain sensitivity assessed with a standardized laboratory task (water load task), functional disability and psychospiritual variables including catastrophizing, self-efficacy, mood, acceptance and mindfulness. Mechanisms of action involved in the proposed beneficial effects of yoga upon clinical outcomes will be explored, and include the mediating effects of visceral sensitivity, increased psychospiritual resources, regulated autonomic nervous system responses and regulated hormonal stress response assessed via salivary cortisol.

Trial registration

ClinicalTrials.gov NCT01107977.     

Screening of coeliac disease in undetected adults and patients diagnosed with irritable bowel syndrome in Riyadh,Saudi Arabia

The present study is to determine the prevalence and implication of coeliac disease (CD) among adult Saudis and compared to those with diagnosed irritable bowel syndrome. This prospective study was conducted among 980 adults. Out of that, 482 subjects (staff and students of Riyadh Health Science College) were designated as control cohorts for undetected coeliac disease. Furthermore, another contingent of 498 subjects diagnosed with irritable bowel syndrome (IBS) at Prince Salman Hospital and Al-Iman General Hospital also constituted a segment of the overall initial 1020 subjects. Both cases and control were tested for serological markers of coeliac disease (tissues transglutaminase (tTGAs) and endomysial autoantibody (EMAs) and were confirmed by histopathology test. All the positive for cases of coeliac disease were screened for iron deficiency anaemia, Vitamin D deficiency, and osteoporosis and weight assessment. The percentage of coeliac disease in control subjects and patients diagnosed with irritable bowel syndrome (IBS) were found to be 1.9% and 9.6% respectively, about 38% of the total coeliac disease patients are among females of middle age (20–39-years) and 16% of the males in the same age range. Whereas, 20% and 25% of all coeliac disease cases with ages of 40–59 were remarked as females and males respectively. The identical nature and overlap of symptoms of the two conditions could possibly result in misdiagnosis of coeliac diseases or over-diagnosis of irritable bowel syndrome. The findings of the study might also give considerable implications of the disease in the nutritional level which is noticeable.     

Biofeedback treatment for headaches,Raynaud's disease,essential hypertension,and irritable bowel syndrome: A review of the long-term follow-up literature

Long-term follow-up evidence for biofeedback treatment of headaches, Raynaud's disease, essential hypertension, and the irritable bowel syndrome was reviewed. Acknowledging the difficulties with cross-study comparisons, the following general success rate were determined: primary idiopathic Raynaud's disease—70%, or better; vascular headache—70%, or better; mixed headache—about 60%; and muscle contraction headache—50%, or less. With relatively fewer patients, successful outcomes with the irritable bowel syndrome and secondary Raynaud's phenomenon were roughly 60% and 40%, respectively. Few cases of clinically significant long-term decreases in diastolic blood pressure were demonstrated; however, the need for medication was reduced or eliminated in some patients. There were indications that biofeedback combined with psychotherapy resulted in highest success rates. No differences were found in effectiveness between biofeedback, other relaxation techniques, and biofeedback in combination with relaxation techniques—all had essentially comparable rates of success. No correlations between physiological and psychological measures of condition at follow-up were reported. Implications and interpretations of these findings are discussed.     

Comparison of various treatments for irritable bowel syndrome.

A previous therapeutic trial of factorial design showed that a combination of a psychotropic drug, a smooth-muscle relaxant, and a bulk former (lorazepam, hyoscine hydrobromide, and ispaghula husk) relieved symptoms of the irritable bowel syndrome more effectively than the same agents given singly. Another trial of similar design was undertaken to compare each of these three agents with another having the equivalent clinical actions--namely, Motival (fluphenazine/nortriptylene mixture), mebeverine, and bran. Ninety-six patients took part; all received three agents, one from each of the three pairs being compared, and no placebos were used. Fifty-six patients reported a sustained symptomatic improvement, which was a significantly higher incidence than in the previous trial, when placebos were used. Ispaghula was significantly more effective than bran. The combination of ispaghula, Motival, and mebeverine improved 11 out of 12 patients--significantly more than bran, Motival, and hyoscine (five improved), or bran, lorazepam, and mebeverine (four improved). Mebeverine was significantly more effective when combined with Motival (18 out of 24 improved) than with lorazepam (10 improved). These results confirm the value of a combined therapeutic approach to the relief of the irritable bowel syndrome and suggest the possibility of synergism between agents.     

L-Dopa in Parkinsonism and the Influence of Previous Thalamotomy

A double-blind cross-over trial over 24 weeks (10 weeks on the active remedy, 4 weeks off treatment, and 10 weeks on placebo) of the effect of L-dopa on idiopathic Parkinsonism (paralysis agitans) has shown no difference in the response obtained in patients who had undergone previous stereotaxic ventrolateral thalamotomy and in those who had not. Of the 34 patients (18 men and 16 women) in the trial 18 had been operated on (nine unilateral, nine bilateral operations) and 16 had not. All patients entering the trial were taking anticholinergic drugs in stable dosage and these were continued throughout. The only factor which seemed to limit the response to treatment was pre-existing hypertension. Of 31 patients who completed the 10-week treatment period, 12 showed marked improvement, 15 moderate improvement, and 4 and mild or negligible change. It seems that previous ventrolateral thalamotomy affords some protection against the development of L-dopa-induced involuntary limb movements on the side contralateral to the operation. As found by others, maximum benefit was seen in bradykinesia and rigidity and related features but a significant reduction in tremor was also noted during treatment. Side effects (nausea, hypotension, and involuntary movements) were common but rarely limited the therapeutic response.     

Bacterial contamination of the small intestine is an important cause of occult malabsorption in the elderly.

A study was conducted to examine the contribution that occult malabsorption makes to malnutrition among elderly patients admitted to an acute geriatric ward. Malnutrition was defined by anthropometric, haematological, and biochemical measurements. Out of 490 patients, 55--many of whom had presented with non-gastrointestinal symptoms--were found to be malnourished. In 31 poor diet alone was probably the cause, but in the remaining 24 patients previously unrecognised malabsorption was detected. Of these patients, 17 were found to have bacterial contamination of the small bowel (nine with duodenojejunal diverticula, four after gastric surgery, and four diagnosed as contamination with "no sump"). In 10 patients contamination was confirmed by culture of intestinal juice: Escherichia coli was predominant in nine cases, and anaerobic organisms in one. Small bowel bacterial overgrowth without a "blind loop" or obvious underlying cause has not previously been fully proved in the elderly. Coeliac disease was detected in two patients, and chronic pancreatitis in two. Occult malabsorption is an important cause of malnutrition in the elderly. Such malnutrition not infrequently occurs in geriatric patients presenting to hospital with non-specific symptoms of physical deterioration.     

Spasmolytic and tonic effect of Iberogast® (STW 5) in intestinal smooth muscle

STW 5 (Iberogast^®) is a fixed combination of nine medicinal plant extracts effective in the treatment of functional dyspepsia and irritable bowel syndrome. The effects of STW 5, a combination of Iberis amara fresh plant extract, and other eight plant extracts as well as single extract components including extracts from Menthae piperitae folium, Matricariae flos and Liquiritiae radix, were assayed in guinea pig ileum with or without stimulation with acetylcholine or histamine, in order to find a possible effect on the contractility of intestinal smooth muscle.STW 5 decreased acetylcholine- and histamine-induced contraction of guinea pig ileum. This was also true for extracts of Menthae piperitae folium, Matricariae flos and L. radix. Extract from I. amara, however, showed no spasmolytic action; in contrary, it increased the basal resting tone and contraction of atonic ileal segments. This was also true when STW 5 was employed.A spasmolytic action of STW 5 could also be observed in duodenum, jejunum and colon.These data are the first to show not only the spasmolytic effects of STW 5 and its component extracts in intestinal muscle but also the tonicising effects of STW 5 through its component Iberis amara extract in relaxed intestinal muscle. Thus, pharmacological evidence suggests a dual-action principle and may explain, at least in part, the clinically observed therapeutic efficacy of STW 5 (Iberogast^®) in both hypotonic and spastic dysmotility symptoms of functional dyspepsia and irritable bowel syndrome.     

Immunoglobulin subclasses of antibodies to human T-cell leukemia/lymphoma virus I-associated antigens in acquired immune deficiency syndrome and lymphadenopathy syndrome

Immunoglobulin G (IgG) and IgM antibodies to human T-cell leukemia/lymphoma virus-I (HTLV-I)-associated membrane antigens (HTLV-I-MA) were assayed by indirect cytospin immunofluorescence, and IgG and IgM antibodies to purified HTLV-I were assayed by enzyme-linked immunosorbent assay in sera from 119 immunologically well-characterized promiscuous male homosexuals in The Netherlands, of whom 9 suffered from acquired immune deficiency syndrome (AIDS), 18 suffered from lymphadenopathy syndrome (LAS), and 5 suffered from gay bowel syndrome. Antibodies to HTLV-I-MA were present in four of nine AIDS patients, including one patient with antibodies to purified HTLV-I. Antibodies to HTLV-I-MA were present in 6 of 18 LAS patients, including 3 patients with antibodies to purified HTLV-I. Of five patients with gay bowel syndrome, one had IgG and IgM antibodies to HTLV-I-MA. Of the four HTLV-I seropositive AIDS patients, two had IgG and IgM antibodies to HTLV-I or HTLV-I-MA, one had only IgG antibodies, and one had only IgM antibodies. Of the six HTLV-I seropositive LAS patients, four had IgG and IgM antibodies to HTLV-I or HTLV-I-MA, and two had only IgM antibodies. In the sera from 27 healthy homosexuals with and 60 without T-cell subset imbalances, no antibodies to HTLV-I or HTLV-I-MA were detected.     

Peppermint oil in irritable bowel syndrome

In a literature search 16 clinical trials investigating 180-200 mg enteric-coated peppermint oil (PO) in irritable bowel syndrome (IBS) or recurrent abdominal pain in children (1 study) with 651 patients enrolled were identified. Nine out of 16 studies were randomized double blind cross over trials with (n = 5) or without (n = 4) run in and/or wash out periods, five had a randomized double blind parallel group design and two were open labeled studies. Placebo served in 12 and anticholinergics in three studies as comparator. Eight out of 12 placebo controlled studies show statistically significant effects in favor of PO. Average response rates in terms of "overall success" are 58% (range 39-79%) for PO and 29% (range 10-52%) for placebo. The three studies versus smooth muscle relaxants did not show differences between treatments hinting for equivalence of treatments. Adverse events reported were generally mild and transient, but very specific. PO caused the typical GI effects like heartburn and anal/perianal burning or discomfort sensations, whereas the anticholinergics caused dry mouth and blurred vision. Anticholinergics and 5HT3/4-ant/agonists do not offer superior improvement rates, placebo responses cover the range as in PO trials. Taking into account the currently available drug treatments for IBS PO (1-2 capsules t.i.d. over 24 weeks) may be the drug of first choice in IBS patients with non-serious constipation or diarrhea to alleviate general symptoms and to improve quality of life.     

Acupuncture and moxibustion for stress-related disorders

Acupuncture and moxibustion, which medical doctors are licensed by the government of Japan to perform, can improve the psychological relationship between doctors and patients, especially when it is disturbed by a “game”, a dysfunctional interpersonal interaction that is repeated unintentionally. This advantage is due to the essential properties of acupuncture and moxibustion. Acupuncture and moxibustion are helpful in treating somatoform disorders, especially musculoskeletal symptoms. In Japan, a holistic acupuncture and moxibustion therapy called Sawada-style has been developed. This is based on fundamental meridian points that are considered to have effects on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the whole body balance. In addition, some of the fundamental points have effects on Qi, blood, and water patterns associated with major depression, generalized anxiety disorder, eating disorders, and somatoform disorders. The fixed protocol of Sawada-style would be suitable for large-scale, randomized, controlled studies in the future. Recent systematic reviews indicate that electroacupuncture would be a useful addition to antidepressant therapy for some symptoms accompanying fibromyalgia. Acupuncture and moxibustion are also recommended for irritable bowel syndrome, instead of Western drug therapy. Surprisingly, the dorsal prefrontal cerebral cortex, which is associated with a method of scalp acupuncture applied for gastrointestinal disorders, has been found to be activated in patients with irritable bowel syndrome. It is quite possible that regulation of this cortical area is related to the effect of scalp acupuncture. This acupuncture method can be effective not only for irritable bowel syndrome but also for other stress-related gastrointestinal disorders.     

腹泻型IBS患者小肠细菌过度生长和抗菌素的影响

目的观察腹泻型肠易激综合征(IBS-D)患者乳果糖氢呼气试验(LHBT)的阳性率、以及短期抗菌素治疗的疗效。方法 89例符合罗马Ⅲ标准的IBS-D患者接受LHBT检测,分析LHBT结果与肠易激综合征(IBS)症状的相关性;16例LHBT阳性IBS-D患者接受"替硝唑或司帕沙星"治疗1周,观察LHBT阴转率及其与症状改善的关系。结果 89例IBS-D患者中,46例(51.7%)LHBT阳性。LHBT阳性组与LHBT阴性组IBS患者在腹痛程度和频率、腹胀程度和频率的差异有统计学意义(P0.05)。16例LHBT阳性的IBS-D患者经1周抗菌素治疗后10例(62.5%)LHBT阴转,IBS症状改善率(Y)与H2呼出量减少率(X)存在正相关关系(回归方程Y=31.3+0.34X,r=0.61,P=0.03)。结论 51.7%IBS-D患者存在小肠细菌过生长(SIBO),SIBO与IBS-D患者的腹痛、腹胀症状有关;短程抗菌素治疗后可以使IBS-D的部分症状获得缓解。     

Effect of wheat bran on weight of stool and gastrointestinal transit time: a meta analysis

Twenty original papers that reported on the effect of wheat bran on large bowel function were analysed. Bran increased the stool weight and decreased the transit time in each study in healthy controls and in patients with the irritable bowel syndrome, with diverticula, and with chronic constipation. Statistical evaluation of the data showed, however, that constipated patients had lower stool output and slower transit whether or not they had taken bran, and they responded less well to bran treatment than controls. From these data it is concluded that bran can be expected to be only partially effective in restoring normal stool weight and transit time in patients who are constipated.     

阿洛司琼联合微生态制剂治疗腹泻型肠易激综合征的临床研究

目的:探究阿洛司琼联合微生态制剂治疗腹泻型肠易激综合征的临床效果。方法:选择2016年1月-2018年1月于我院进行治疗的96例腹泻型肠易激综合征患者为研究对象,按照随机数字表法将其均分为实验组与对照组,每组各48例。对照组患者单纯使用阿洛司琼治疗,实验组患者在对照组患者基础上加用微生态制剂,两组患者治疗时间均为4周,分别于干预前及干预后对两组患者症状进行评分,使用IBS病情严重程度调查表(IBS-SSS)对两组患者干预前后治疗效果进行评估,并比较两组患者干预前后肠道乳酸杆菌、肠球菌及酵母样真菌菌群数及生活质量(SF-36)评分。结果:干预后,实验组患者症状评分及IBS-SSS量表评分均显著低于对照组(P0.05),SF-36生理功能、心理功能及生活功能得分、乳酸菌及肠球菌菌群数均显著高于对照组,而酵母样真菌菌群数低于对照组(P0.05)。结论:阿洛司琼联合微生态制剂治疗腹泻型肠易激综合征能够有效改善患者的肠道菌群、有效缓解临床症状,并可显著提高患者的生活质量。     

Colonic Response to Pentazocine

The effects of pentazocine on colonic motor activity were studied in five normal subjects, five patients with irritable bowel syndrome, and five patients with diverticular disease. The drug decreased intraluminal colonic pressures in all patients but one. Since morphine, which increases intraluminal colonic pressures, is contraindicated in patients with abdominal pain of colonic origin (diverticular disease, irritable bowel syndrome), we suggest that pentazocine may be a useful drug in such cases.     

How trustworthy are bowel histories? Comparison of recalled and recorded information.

One hundred and fifty hospital outpatients were questioned about their bowel habits and then asked to record these in diary booklets for two weeks. Overall, recalled and recorded figures for frequency of defecation agreed fairly closely, but in 16% of patients there was a discrepancy of three or more bowel actions per week. This was usually an exaggeration of the difference from the norm of one a day. Patients were bad at predicting episodes of changed bowel frequency. These findings cast doubt on the value of population surveys of bowel habit based solely on questionnaires. They also suggest that the irritable bowel syndrome might be correctly diagnosed more often if patients were routinely asked to record their bowel actions.     

Relaxation training as a treatment for irritable bowel syndrome

Although there have been many successful, controlled demonstrations of the clinical efficacy of multicomponent treatments for irritable bowel syndrome (IBS), in the present study we sought to evaluate a single component of many of these regimens, relaxation training. Eight IBS patients received a 10-session (over 8 weeks) regimen of abbreviated progressive muscle relaxation with regular home practice while 8 comparable patients merely monitored GI symptoms. Based on daily GI symptom diaries collected for 4 weeks before and 4 weeks after treatment (or continued symptom monitoring), the Relaxation condition showed significantly (p=.05) more improvement on a composite measure of primary GI symptom reduction than the Symptom Monitoring condition. Fifty percent of the Relaxation group were clinically improved at the end of treatment.     

Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients.

OBJECTIVE: To measure the prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and determine risk factors and associations with postdysenteric symptoms. DESIGN: Postal questionnaire. SETTING: Nottingham Health Authority. SUBJECTS: 544 people with microbiologically confirmed bacterial gastroenteritis between July 1994 and December 1994. MAIN OUTCOME MEASURES: Prevalence of gastrointestinal symptoms and relative risks for development of the irritable bowel syndrome and self reported altered bowel habit. RESULTS: A quarter of subjects reported persistence of altered bowel habit six months after an episode of infective gastroenteritis. Increasing duration of diarrhoea, younger age, and female sex increased this risk, whereas vomiting as part of the illness reduced the risk. One in 14 developed the irritable bowel syndrome with an increased risk seen in women (relative risk 3.4: 95% confidence interval 1.2 to 9.8) and with duration of diarrhoea (6.5; 1.3 to 34 for 15-21 days). CONCLUSIONS: Persistence of bowel symptoms commonly occurs after bacterial gastroenteritis and is responsible for considerable morbidity and health care costs.