Treatment of irritable bowel syndrome with lorazepam,hyoscine butylbromide,and ispaghula husk.

A double-blind controlled therapeutic trial of factorial design was used to study the therapeutic effects of lorazepam, hyoscine butylbromide, and ispaghula husk in 12 randomised blocks of eight patients with the irritable bowel syndrome (IBS). Each of the three agents caused a sustained symptomatic improvement in some of the patients, although only with ispaghula was the difference between the real and dummy preparation statistically significant. When the eight possible combinations of treatment were analysed none of the 12 patients who received only dummy preparations of the three agents had maintained any improvement over the three months of the trial. Seven patients improved among the 12 who received potent preparations of all three agents, and between four and six patients improved in the groups receiving one or two of the potent preparations. These therapeutic results, though far from perfect, show that the types of drug commonly used to treat IBS are of some value and may be additive in their effects. Similar combinations of other therapeutic agents may be more effective, but it will be possible to determine this only by carrying out factorial therapeutic trials.     

Irritable bowel syndrome and abdominoplasty

Irritable bowel syndrome is a chronic disease involving pain or discomfort relieved by defecation and associated with a change in frequency or consistency of the stools. The effect of abdominoplasty on patients with irritable bowel syndrome has not been elucidated, so advising patients with irritable bowel syndrome about the effects of surgery on their disease was difficult. One hundred female patients from a pool of 120 patients responded to a questionnaire relating to abdominoplasty surgery. Follow-up ranged from 6 months to 2 years. Patients completed questionnaires formulated on the basis of Rome II Diagnostic Criteria. Of the 100 patients, nine had true irritable bowel syndrome, nine had moderate symptoms and were receiving medication (not true irritable bowel syndrome), 16 had mild symptoms on occasional medication, and 66 had no symptoms of irritable bowel syndrome before surgery. Of the true irritable bowel syndrome patients, all had symptomatic improvement with decreased medication, eight of the nine patients with moderate symptoms improved markedly, and five of the 16 patients with mild symptoms improved significantly. No patient had any initiation or deterioration of symptoms. It is thus concluded that the symptoms of irritable bowel syndrome are certainly not worsened, in the short term, by surgery, and may be alleviated or improved in most significant cases.     

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.     

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.     

Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial.

Fifty-eight patients with uncomplicated diverticular disease of the colon took bran crispbread, ispaghula drink, and placebo for four months each in a randomised, cross-over, double-blind controlled trial. Assessments were made subjectively, using a monthly self-administered questionnaire, and objectively, by examining a seven-day stool collection at the end of each treatment period. In terms of a pain score, lower bowel symptom score (the pain score and sensation of incomplete emptying, straining, stool consistency, flatus, and aperients taken), and total symptom score (belching, nausea, vomiting, dyspepsia, and abdominal distension) fibre supplementation conferred no benefit. Symptoms of constipation, however, when assessed alone, were significantly relieved. Both fibre regimens produced the expected changes in stool weight, consistency, and frequency. It is concluded that dietary fibre supplements in the commonly used doses do no more than relieve constipation. Perhaps the impression that fibre helps diverticular disease is simply a manifestation of Western civilisation''s obsession with the need for regular frequent defecation.     

Irritable Bowel Syndrome Is Positively Related to Metabolic Syndrome: A Population-Based Cross-Sectional Study

Irritable bowel syndrome is a common gastrointestinal disorder that may affect dietary pattern, food digestion, and nutrient absorption. The nutrition-related factors are closely related to metabolic syndrome, implying that irritable bowel syndrome may be a potential risk factor for metabolic syndrome. However, few epidemiological studies are available which are related to this potential link. The purpose of this study is to determine whether irritable bowel syndrome is related to metabolic syndrome among middle-aged people. We designed a cross-sectional study of 1,096 subjects to evaluate the relationship between irritable bowel syndrome and metabolic syndrome and its components. Diagnosis of irritable bowel syndrome was based on the Japanese version of the Rome III Questionnaire. Metabolic syndrome was defined according to the criteria of the American Heart Association scientific statements of 2009. Dietary consumption was assessed via a validated food frequency questionnaire. Principal-components analysis was used to derive 3 major dietary patterns: “Japanese”, “sweets-fruits”, and “Izakaya (Japanese Pub) “from 39 food groups. The prevalence of irritable bowel syndrome and metabolic syndrome were 19.4% and 14.6%, respectively. No significant relationship was found between the dietary pattern factor score tertiles and irritable bowel syndrome. After adjustment for potential confounders (including dietary pattern), the odds ratio (95% confidence interval) of having metabolic syndrome and elevated triglycerides for subjects with irritable bowel syndrome as compared with non-irritable bowel syndrome are 2.01(1.13–3.55) and 1.50(1.03–2.18), respectively. Irritable bowel syndrome is significantly related to metabolic syndrome and it components. This study is the first to show that irritable bowel syndrome was significantly related to a higher prevalence of metabolic syndrome and elevated triglycerides among an adult population. The findings suggest that the treatment of irritable bowel syndrome may be a potentially beneficial factor for the prevention of metabolic syndrome. Further study is needed to clarify this association.     

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。     

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。     

Modulation of electrical activity in gastrointestinal smooth muscle by peptides.

A rise in intracellular calcium is the predominant signal that leads to the activation of the contractile machinery in gastrointestinal smooth muscle. The primary sources of activating calcium are illustrated in Fig. 2. Voltage- and peptide-mediated release of intracellular calcium contribute to activation of some gastrointestinal smooth muscles. However, the primary source of activating calcium appears to be an influx of calcium across the plasma membrane. The degree of modulation of electrical activity by peptides varies depending upon the region of the gastrointestinal tract studied. Second messenger systems are undoubtly involved in the transduction pathway for receptor-mediated changes in ion channel activity in gastrointestinal smooth muscle. However, in comparison to other excitable cell types, little is known about the coupling mechanisms whereby peptide-receptor binding alters ion channel activity in gastrointestinal smooth muscle. This represents one of the challenging areas to be studied in the field of gastrointestinal smooth muscle. One disease in which a better appreciation of the regulation of ion channel activity could lead to therapeutic benefit is irritable bowel syndrome. A coupling of smooth muscle electrical activity to hypermotility in irritable bowel syndrome has been reported. CCK increases the level of spike activity which triggers hypermotility [40]. It would follow that inhibition of calcium influx should reduce spiking and, therefore, hypermotility. In fact, the calcium channel blockers nifedipine and nicardipine have been shown to decrease colonic motility in irritable bowel syndrome patients [62-64]. As our understanding of gastrointestinal smooth muscle ion channels expands, development of a gastrointestinal selective calcium channel blocker may be possible. This class of agents would be effective in the treatment of irritable bowel syndrome and potentially other peptide-related spastic smooth muscle disorders.     

Psychoneurotic symptomatology in the irritable bowel syndrome: a study of reporters and non-reporters.

An appreciable proportion of the general population have the irritable bowel syndrome but do not report it. Results of psychological assessments showed that outpatients with the syndrome and non-reporters of it were psychologically similar, but both groups showed more somatic distress than normal controls. Anxiety, depression, obsessive compulsion, and interpersonal sensitivity were similar in both groups with the syndrome and the normal controls. The preponderance of women referred to outpatient clinics may reflect sociological factors rather than the severity of the irritable bowel syndrome.     

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.     

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.     

Controlled Clinical Trial of Mepiprazole in Irritable Bowel Syndrome

The effect of a new tranquillizer, mepiprazole, in the treatment of the irritable bowel syndrome has been studied in a double-blind cross-over trial in 19 patients. After examination to exclude organic disease the patients were followed up over two treatment periods of four weeks each under either placebo or the active principle, each patient being his own control. The results indicated that the drug had a beneficial effect (P < 0·05) provided that it was given for a period of at least three weeks.     

Serotonin transporter: gene, genetic disorders, and pharmacogenetics

The highly evolutionarily conserved serotonin transporter (SERT) regulates the entire serotoninergic system and its receptors via modulation of extracellular fluid serotonin concentrations. Differences in SERT expression and function produced by three SERT genes and their variants show associations with multiple human disorders. Screens of DNA from patients with autism, ADHD, bipolar disorder, and Tourette's syndrome have detected signals in the chromosome 17q region where SERT is located. Parallel investigations of SERT knockout mice have uncovered multiple phenotypes that identify SERT as a candidate gene for additional human disorders ranging from irritable bowel syndrome to obesity. Replicated studies have demonstrated that the SERT 5'-flanking region polymorphism SS genotype is associated with poorer therapeutic responses and more frequent serious side effects during treatment with antidepressant SERT antagonists, namely, the serotonin reuptake inhibitors (SRIs).     

脾虚证IBS模型WHBE兔血浆环核苷酸水平的变化

目的观察脾虚型肠易激综合征（IBS）模型WHBE兔环核苷酸水平的变化。方法取WHBE兔和日本大耳白兔各18只,分别随机分成两组,即正常对照组6只,模型对照组12只,采用湿热应激加灌服番泻叶煎剂的方法造成脾虚证肠易激综合征（tBs）免模型,其中模型对照组造模后处理6只,剩余兔自然恢复10d,观察实验兔的血浆环核苷酸水平的变化。结果与正常对照组比较,WHBE兔模型对照组血浆cAMP和cGMP水平均显著升高（P〈0．05,P〈0．01）,且自然恢复10d后血浆cAMP和cGMP水平仍高于正常对照组（P〈O．05,P〈O．01）;日本大耳白兔模型对照组造模后及自然恢复10d后血浆cAMP和cGMP水平略有所升高,但差异均不显著（P〉O．05）;且模型对照组和自然恢复组cAMP／cGMP比值均略低于正常对照组,但差异不显著（P〉O．05）。结论本实验脾虚证IBS模型兔的血浆环核苷酸水平随阴阳盛衰而变化,具有双重特点：既有阴虚特点,又有阳虚特点,且WHBE兔更适合于脾虚证IBS模型研究理想的实验动物。     

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.     

微生态制剂(贝飞达)治疗非便秘型肠易激综合征

目的探讨微生态制剂贝飞达对肠易激综合征（IBS）的疗效。方法采用中国预防医学科学院流行病学研究所海斯药业有限公司生产的双歧三联活菌胶囊贝飞达（长双歧杆菌、嗜酸乳酸杆菌、粪肠球菌）治疗25例IBS患者,与服用安慰剂组25例进行疗效对比分析。结果IBS特征性症状评分治疗前后的差值,治疗组明显高于安慰剂组,各种症状的改善率明显优于对照组。结论贝飞达的短期疗法有望成为IBS治疗中的一个颇有前途的手段。     

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.     

Globus and headache: common symptoms of the irritable bowel syndrome.

Persons with the irritable bowel syndrome (IBS) have a significantly higher prevalence of globus and migraine-like headache than age-matched control subjects. On the other hand, persons with organic disease of the esophagus or colon may have a reduced prevalence of functional symptoms involving the opposite end of the gastrointestinal tract. The dispersed pattern of symptoms in IBS suggests that some agent, such as a hormone, may be acting systemically.     

Comparison of Treatment Outcome Measures for Irritable Bowel Syndrome

We have examined the relations among three common treatment outcome measures in irritable bowel syndrome (IBS): end of treatment global ratings by a physician, end of treatment patient global ratings, and measures derived from a daily symptom diary completed by the patient. Eighty-four IBS patients (53 female, 31 male) participated in a randomized controlled evaluation of three psychological treatment conditions for IBS. Treatment outcome measures from this trial (Blanchard et al., 1992) were used in the present methodological study. Physician global ratings were significantly correlated with patient global ratings (r = .45, p < .01). Both of these global ratings also correlated significantly with a composite score from patient diary ratings. Multiple regression analyses revealed that reductions in bloating and constipation account for 18% of the variance in patient global ratings. Global ratings at end of treatment by either patient or physician were only partially related to symptom relief as measured by a daily diary.