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Irritable Bowel, Pain Syndromes Linked
IBS Patients 60% More Likely to Suffer
Fibromyalgia, Migraine, Depression
By Daniel J. DeNoon
Doctors have long suspected a link between irritable bowel syndrome, pain syndromes, and depression. New data now strongly support this theory.
The findings come from data on 97,593 people with irritable bowel syndrome enrolled in a large U.S. health plan from 1996 to 2002. J. Alexander Cole, DSc, MPH, and colleagues at Boston University compared these patients with 27,402 people seeking routine health care.
Their results show that people with irritable bowel syndrome are:
80% more likely to suffer fibromyalgia
60% more likely to suffer migraine
40% more likely to suffer depression
Overall, 60% more likely to suffer fibromyalgia, migraine, or depression
"Perhaps what is driving the relation between irritable bowel syndrome and these other conditions is some underlying biological disorder," Cole tells WebMD. "Nobody is sure what this could be. But people suggest that there is this constellation of symptoms among people with irritable bowel syndrome, fibromyalgia, migraine, and depression that might present in different ways."
Cole and colleagues report their findings in the Sept. 28 issue of the online journal BMC Gastroenterology.
Common Cause of Pain Syndromes?
Cole, now an epidemiologist with i3 Drug Safety, is not an expert on irritable bowel syndrome. Reza Shaker, MD, is. Shaker, chief of gastroenterology and hepatology at the Medical College of Wisconsin, was not involved in the Cole study.
"Clinical observations of patients with pain syndromes indicate that we are dealing with a syndrome bigger than a single organ," Shaker tells WebMD. "These findings confirm these previous observations."
Shaker says people with irritable bowel syndrome and people with pain syndromes such as fibromyalgia and migraine have something in common. They all have nerve pathways which somehow have become vastly oversensitive to pain signals -- a process doctors call sensitization.
Perhaps, Shaker suggests, there's a common problem at the crossroads where these nerve pathways intersect.
"Is it possible that there is an event -- possibly an early life event -- that affects the crossroads of all these nerve pathways?" he asks. "In areas where these nerves cross, it could be that there is sensitization occurring, affecting different neural circuits."
Cole suggests that different doctors looking at the same underlying illness might make different diagnoses. A gastroenterologist, for example, might diagnose irritable bowel syndrome, while a rheumatologist might diagnose fibromyalgia.
This sounds a lot like the blind men who, on first encountering an elephant, declare it to be like a snake or a tree depending on whether they are touching the elephant's trunk or its leg. Shaker says this analogy is apt. But most doctors, he says, will examine the whole elephant, not just its parts.
"A professional doesn't just focus on one symptom. If we see irritable bowel syndrome along with noncardiac chest pain or fibromyalgia, then we tackle this," he says. "But we doctors need to have a more global picture of this, instead of pigeonholing our diagnosis according to our own specialty or subspecialty."
Fermentation May Be At
Root Of Irritable Bowel Syndrome
LONDON, ENGLAND -- Irritable bowel syndrome (IBS) is one of the most common reasons that
people go to see a gastroenterologist. People with this disorder experience intermittent
bouts of abdominal pain, usually accompanied by diarrhoea or constipation. About half of
patients with IBS report that certain foods make their symptoms worse. Why this might be
so is unknown, but one theory is that these foods contain substances easily fermented by
the bacteria normally found in the colon.
To find out, Dr. T. S. King and
colleagues from Cambridge, England, recruited 12 women to participate in an experiment.
The results of the study appear in this week’s issue of The Lancet.
Six of the women had IBS, and six had no
gastrointestinal difficulties. All women adhered to two different diets, each for two
weeks. One diet was a standard diet with normal western foods. The second was a diet often
prescribed to IBS patients, which sometimes helps reduce their symptoms. This diet
excludes beef, dairy products, all cereals except rice and restricts the consumption of
foods with yeast, citrus fruits, caffeinated drinks and tap water.
On the last day of each two-week diet,
the women spent 24 hours under a plastic canopy allowing the investigators to sample the
gases they produced, such as hydrogen and methane. Breath samples, which can be used to
monitor a person's gas production, were also taken every 30 minutes during waking hours.
All faeces passed during the final 72 hours of the diet were collected and analysed.
Dr King and colleagues report that while
on the standard diet, both groups of women produced about the same amount of gas. However,
the IBS women produced more hydrogen and produced gas more rapidly, indicating an increase
in fermentation.
"In four of the six [IBS] patients,
symptoms occurred when gas excretion was rapid," the investigators write.
These patients were then put on the
restricted diet and the rate at which they produced gas fell dramatically and their
symptoms improved. Although it is unlikely that the gas alone causes discomfort, the
investigators explained, it may be that other chemicals produced by fermentation are to
blame, producing the symptoms either by causing local effects in the bowel, or perhaps
affecting the nervous system.
Common Foods
Known to Aggravate IBS.
Some foods have been identified as "Trigger Foods" for a large segment of IBS
patients. Eating these foods have been shown to trigger symptoms.
They include:
Alcohol
Carbonated drinks
Coffee
Dairy products
Fried foods
Poultry skin, chicken, turkey, duck, goose etc.
Red meat.
Eliminating foods from your diet can upset the balance of your dietary needs. The best way to tackle this problem would be to work with a qualified nutritionist. Knowing that the average person can not afford to do this, we suggest you find an online support group, where people who are knowledgable on this subject can help you. Check with your doctor, the internet and your local library for suggestions on getting the proper nutrition while eliminating foods from your diet.
You may also benefit from eating rice, or potatos instead of bread. Some people find relief after eliminating gluten from their diet. There are many sources for gluten free flour.
Zelnorm available to U.S. patients under restricted access program
(July 27, 2007) The U.S. Food and Drug Administration (FDA) has approved a protocol that allows limited access to the drug Zelnorm for the treatment of chronic idiopathic constipation, or of IBS where constipation is the predominant bowel symptom. Access will be restricted to women under the age of 55 who meet special enrollment criteria administered through their doctor. Women interested in obtaining Zelnorm are encouraged to contact their doctor.
News from Novartis
(July 27, 2007) In cooperation with the US Food and Drug Administration (FDA), Novartis has established a restricted access program for Zelnorm® (tegaserod maleate) so that patients in need of this medicine can be considered for treatment.
The program, called a treatment IND, is designed to help women in the US under 55 years of age who suffer from irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC), and for whom no other treatment has provided satisfactory relief and/or patients who had satisfactory improvement of their symptoms with prior Zelnorm treatment for IBS-C or CIC. Novartis and the FDA are moving forward with this program because of requests from physicians and patients following the marketing suspension of Zelnorm in March 2007.
Treatment INDs are generally used to allow restricted access to medications for patients in need if no comparable alternative drug or therapy is available to treat the disease. Patients given access through a treatment IND must meet specific FDA-approved criteria for enrollment.
Through the program, appropriate female patients with IBS-C or CIC who are assessed by their physicians as being in critical need can have access to Zelnorm for relief of the often painful and disruptive symptoms associated with these conditions. The program protocol and consent materials are designed to ensure that patients and physicians are fully informed of the potential risks and benefits of Zelnorm.
To be considered for access to Zelnorm through the treatment IND, patients must have IBS-C or CIC and meet the specific criteria in the treatment IND protocol. To become part of the treatment IND, patients should contact their physicians to inquire about the protocol and evaluate if they meet the criteria. For further details of the program’s protocol, physicians can call 866-248-1348 or 888-669-6682 or go to www.zelnorm.com.
For patients who do not meet the criteria of the treatment IND but have an urgent need for Zelnorm based on a life-threatening or severely debilitating condition, there may be an alternative option available through the FDA. Physicians may inquire about this potential access option by contacting Novartis at (888-NOW-NOVA) or the FDA CDER Division of Drug Information at 301-827-4570 or www.fda.gov/cder.
Novartis suspended US marketing and sales of Zelnorm as a result of an FDA request in order to permit further discussion of its benefit/risk profile. This decision was based on a review of a new retrospective analysis of pooled clinical trial data which showed that the incidence of cardiovascular ischemic events was higher in patients taking Zelnorm than in those taking placebo. However, no causal relationship between Zelnorm and cardiovascular ischemic events has been demonstrated.
Novartis has extensively studied Zelnorm and believes that this medicine provides important benefits for appropriate patients. Novartis is in discussions with the FDA to better understand the findings and to determine appropriate next steps.
Colonics, also known as colon hydrotherapy or colonic irrigation, involve the use of warm, sterile water which is inserted into the rectum to wash out waste products from the colon, the final section of the intestines. This process is not meant to be painful, but because IBS sufferers are often very sensitive to gut contractions it may be uncomfortable or even painful for some sufferers.
Many doctors warn against using colonics because they believe that they can alter the balance of friendly bacteria in the intestines. Colonic therapists, however, argue that while colonics can remove some friendly bacteria, they will also remove harmful bacteria and waste products from the colon, giving the good bacteria a better environment in which to live.
Many colonic therapists claim that years and years of fecal matter can become stuck in our guts and attached to the walls of our intestines. However, there is no medical or clinical evidence to suggest that this is true. Patients may of course be chronically constipated, but most people will have perfectly clean intestines, as shown by the cameras used during colonoscopies and by the observations of surgeons during intestinal surgery.
Many colonic therapists will also offer advice on diet and supplements, and this advice may in fact be more useful than the colonic itself.
What symptoms do colonics treat?
Colonics are most often associated with treating symptoms of constipation. However, therapists claim good results with other digestive disorders as well. There is no medical evidence to show that colonics can provide any long-term benefits for IBS.
What happens during a colonics session?
A medical history will be taken by the therapist, and you will then be asked to remove your clothing and put on a special gown. You will then lie down, and warm water will be inserted via a pipe into your rectum.
The therapist will use massage and
pressure techniques to help dislodge old waste material from the colon, which will flow
out of your body through the pipe. There should not be any odor during the treatment.
Return To Index
Gut-directed Hypnotherapy for IBS
Gut-directed hypnotherapy is a special form of hypnotherapy developed for IBS and digestive disorder sufferers. It uses the therapeutic qualities of hypnotherapy, such as deep relaxation, and adds gut-specific treatments and suggestions.
Hypnotherapy is a well-established treatment for IBS and there are many scientific studies which show that it can improve IBS symptoms. This kind of hypnotherapy should not be confused with the stage hypnosis used for entertainment, as the hypnotherapist will not be able to make a patient do anything they do not wish to - you remain in control of your actions during treatment.
The exact mechanism of how hypnotherapy works is still poorly understood.
What symptoms can hypnotherapy treat?
This form of hypnotherapy is designed to treat all symptoms of IBS.
What happens during hypnotherapy?
A hypnotherapist will take some background details about your IBS experiences and symptoms. Then they will coax you into a state of extreme relaxation, and take you through a program of suggestion. For example, you may be asked to imagine that when you hold your hand over your stomach a healing warmth is flowing into your abdomen, or you may be asked to visualize a fully working digestive system.
Patients remain in complete control of their actions at all times. A therapist may record each session onto audio cassette to allow the patient to maintain their therapy between sessions and use the tape when they feel they need it.
If you are unable to attend regular sessions with a hypnotherapist or cannot afford the sessions, the IBS Audio Program 100 offers an alternative, as it is a self-hypnosis program designed to be used in the home.
How successful is hypnotherapy in clinical studies?
There have been a range of clinical studies which show that hypnotherapy can help IBS.
The pioneer for this kind of treatment was Dr Peter Whorwell, a UK doctor who published his first study in the journal The Lancet in 1984. The placebo-controlled study consisted of 15 IBS patients who received seven hypnotherapy sessions, and 15 patients who received seven sessions of psychotherapy and placebo pills.
The patients who received psychotherapy showed a small improvement in their abdominal pain and general well-being, but not in their typical IBS symptoms such as diarrhea and constipation. The patients who had received hypnotherapy showed a major improvement in all main symptoms, and remained well during the three-month period of follow-up research.
Conclusion: In 1997 the American Journal of Gastroenterology published a study (Gonsalkorale WM, Houghton LA, Whorwell PJ) which looked at 250 patients, who were given 12 hypno sessions plus home practice sessions. Overall, the severity of IBS symptoms was reduced by half, and there were also marked improvements in quality of life, anxiety and depression.
Conclusion: Hypnotherapy can greatly reduce IBS symptoms.
A review of 14 previous clinical studies was published in the American Journal of Clinical Hypnosis (Tan G, Hammond DC, Joseph G) in 2005. Eight of the studies had used a control group, and six studies had no control group.
Bacteria May Be the Cause of Irritable Bowel Syndrome
09-10-2004 A USC researcher considers new ways to treat a gastrointestinal condition that affects millions of Americans. The approach represents a reversal in thinking, offering hope for patients.
By Alicia Di Rado
The enigmatic-but-common condition known as irritable bowel syndrome, or IBS, is caused by an overgrowth of bacteria in the small intestine, a USC researcher has proposed in the Journal of the American Medical Association.
Researchers have suggested numerous theories to explain IBS, which affects as many as 36 million Americans. But according to gastrointestinal motility specialist Henry C. Lin, associate professor of medicine in the Keck School of Medicine of USC, the idea of a bacterial origin of IBS represents a major change in thinking.
Writing in the Aug. 18 issue of JAMA, Lin proposed that ordinary bacteria normally confined to the large intestine may expand into the small intestine, prompting uncomfortable bloating and gas after meals, a change in bowel movements as well as an immune response that may account for the flu-like illness so common in the IBS patient, including such debilitating symptoms as headaches, muscle and joint pains and chronic fatigue.
"IBS has long been a frustrating diagnosis for both patients and their physicians," Lin said. "The bacterial hypothesis of IBS offers new hope for suffering patients by providing a new framework for understanding the symptoms of this disorder, pointing to new strategies for treatment."
Physicians frequently diagnose a patient with IBS when ongoing symptoms - including diarrhea, constipation, bloating, gas and abdominal pain - are not explained by medical tests such as gastrointestinal endoscopies.
For more than a dozen years, Lin has searched for a common thread to account for the symptoms in IBS. Studies indicate 92 percent of IBS patients report bloating after they eat, a symptom he saw again and again in his patients.
While many physicians believe that IBS-related bloating is perceived and not real, Lin noted that recent studies of IBS patients show that their abdomens do become measurably more distended than those of healthy patients.
With the symptom of post-meal bloating in mind, Lin began the quest for the cause of IBS by considering the problem of increased intestinal gas.
Gas comes about when gut bacteria ferment food in the intestinal tract. There are plenty of organisms in the gut, where bacteria may number 100 trillion.
Bacteria perform a variety of valuable services in the large intestine, according to Lin. "But we believe problems may start when bacteria set up shop in the small intestine where they are normally scarce. Usual medical tests such as endoscopy cannot detect this problem in most patients," he said.
However, a breath test can be used to indirectly tell if too many bacteria are in the small intestine. In this test, the patient ingests a syrup containing the sugar lactulose. Over the next three hours, the gaseous products of bacterial fermentation of this sugar may be measured in the exhaled breath.
In a 2003 paper authored by Lin and his research partner Mark Pimentel of Cedars-Sinai Medical Center, 84 percent of IBS patients were found to have abnormal breath test results suggesting small intestinal bacterial overgrowth.
In this double-blind, placebo-controlled study, patients received either antibiotic therapy or a sugar pill. Patients whose small intestinal bacterial overgrowth was eradicated by antibiotics reported a 75 percent improvement in symptoms.
Small intestinal bacterial overgrowth allows gut bacteria to cross the mucosal barrier, which is the lining of the gut, and enter the body. This activates the patient's immune system as evidenced by increased numbers of inflammatory cells in tissues of IBS patients.
"The immune response to bacterial antigens may then explain the flu-like symptoms that can greatly diminish the quality of life such as chronic fatigue and pain," Lin said.
The Jill and Tom Barad Family Fund supports Lin's current bacterial overgrowth research. His other research projects are supported by the National Institutes of Health.
Hypnotherapy for Irritable Bowel Syndrome Works for "At Least Five Years"
Long term benefits of hypnotherapy for irritable bowel syndrome 2003; 52: 1623-9
Hypnotherapy seems to be an effective long term treatment for irritable bowel syndrome (IBS), lasting for "at least five years," conclude researchers in this month's edition of Gut.
IBS is a very common disorder and makes up half a gastroenterologist's workload. Conventional treatment of IBS often does not work very well.
The researchers base their findings on questionnaires regularly completed by over 200 patients with IBS. These patients scored their symptoms, quality of life, and levels of anxiety and depression before, immediately after, and up to six years after being given hypnotherapy. Sessions lasted one hour for up to 12 weeks.
Almost three quarters of the patients responded well to hypnotherapy (71%), and most of these did not deteriorate over time, while the remainder claimed their deterioration had been slight. Women were more likely to respond than men
Among those who responded, all registered a significant improvement in symptoms compared with what these had been like before treatment, and there was very little difference in how these were rated for more than five years after treatment.
Scoring for quality of life and levels of anxiety and depression also significantly improved, but did begin to tail off slightly over time. But patients also said they took fewer drugs and did not need to see their doctors as often after they had had a course of hypnotherapy.
The researchers say that the sustained improvements in most of the patients seen cannot be attributed to other treatments as fewer than one in 10 patients attempted alternatives after completing their hypnotherapy sessions.
The researchers, who work at the first NHS hypnotherapy unit to be established in the UK, say that previous research has found that hypnotherapy for IBS works in the short term, but their study shows that it also works in the long term.
Critics have complained that the number of sessions needed for hypnotherapy to be effective make it a costly option, but the authors contend that its sustained effects, with the accompanying reduction in use of prescription drugs and consultations with doctors, more than offset these costs.
Click here to view the full paper:
http://press.psprings.co.uk/gut/november/1623_gt17244.pdf
[Please note this link will remain live for one month only after issue]
Actual stress, psychopathology and salivary cortisol levels in the irritable bowel syndrome (IBS).
J Endocrinol Invest 2001 Mar;24(3):173-7
Patacchioli FR, Angelucci L, Dellerba G, Monnazzi P, Leri O. Department of Physiology and
Pharmacology V. Erspamer, Medical Faculty, University of Rome La Sapienza, Italy.
Although irritable bowel syndrome (IBS) can be considered a biopsychological disorder in
which an association between life stress and physiological changes leading to bowel
irregularity is present, there is a lack of data concerning possible modifications of the
adrenal function during the disease. The aim of the present study was to measure
biological and psychological variables related to the activity of the
hypothalamo-pituitary-adrenal axis in IBS patients compared to healthy subjects. Cortisol
was measured in the saliva (obtained by a stress-free, non invasive collection procedure)
of 55 IBS outpatients and 28 matched controls. Moreover, each subject completed the
following self-administered questionnaires: the Rome Burnout Inventory (RBI) in its
physical (RBI-PE) and emotional-mental exhaustion (RBI-EME) components, Beck Depression
Inventory, State and Trait Anxiety Inventory (STAI), Perceived Social Support Scale (PSSS)
and a Scale for the Assessment of Perceived Actual Work-Non Work Stress. Compared with
controls, IBS subjects showed significantly higher levels of cortisol in the morning and
lower in the evening, while they maintained the physiological circadian fluctuation (i.e.
cortisol morning level higher than in the evening). Moreover, IBS patients presented a
significant difference from controls in RBI-PE scores, which confirms the presence of
fatigue, a symptom frequently reported by the patients. Compared with controls, no
differences were found in IBS patients with respect to other psychological parameters.
These findings suggest a dysregulation of the adrenal activity in IBS patients. The
results may be relevant considering that changes in cortisol levels have been shown to be
sensitive indicators of psychosocial stress and coping patterns in both laboratory and
life situations.
When to conduct
testing in patients with suspected irritable bowel syndrome.
Rev Gastroenterol Disord. 2003;3 Suppl 3:S18-24. Talley NJ. Center for Enteric
Neurosciences and Translational Epidemiologic
Research, Mayo Clinic, Rochester, MN.
Patients who have abdominal discomfort or pain plus disturbed defecation warrant a careful
history taking and physical examination. The presence
of positive symptom criteria for irritable bowel syndrome (IBS) usually correctly
identifies the underlying IBS diagnosis. The clinical
evaluation may uncover findings that cause concern about underlying organic disease
("alarm features" or "red flags"). Traditional alarm
features include bleeding, obvious anemia, weight loss, and older age at onset. Although
the diagnostic utility of most of these red flags has
not been tested, patients with these symptoms should be investigated promptly. In the
primary care setting, most patients who have alarm
symptoms will have a negative further evaluation, and the original IBS diagnosis will be
confirmed. In the past, numerous tests (eg, complete
blood cell count, flexible sigmoidoscopy) were considered routine for patients with
suspected IBS in the primary care setting. However,
available data do not support this approach; these patients do not have an increased
likelihood of most organic diseases compared with control
populations without IBS. Although celiac disease may occur more frequently in persons with
IBS, the yield of serologic testing is likely
to be low. Testing is generally not required in patients with positive symptom criteria
for IBS and an absence of alarm features.
PMID: 14502113
Nerve Receptor
Found to Be Key to Intestinal Inflammation
By Duke Researchers
DURHAM, N.C. -- Researchers at Duke University Medical Center have found that a specific
nerve cell receptor appears to be necessary to initiate the
development of inflammatory bowel disease (IBD), findings they believe could change how
physicians treat this disorder.
The results of their studies, which were carried out in rats, could point toward a
potential therapy aimed at blocking the receptor, known as
vanilloid receptor type 1 (VR-1). Interestingly, they said, VR-1 is the receptor on
sensory neurons that receives and transmits the "heat" and
"pain" impulses felt when eating raw chili peppers.
The results of the Duke study were reported today (May 1, 2003) in the May 2003 issue of
the journal Gut.
IBD is a general term given to a constellation of chronic disorders in which the intestine
becomes inflamed, typically resulting in recurring abdominal
cramps, pain and diarrhea, in some cases bloody. The cause of IBD is unknown, and it is
believed that up to 2 million Americans suffer from this
disorder, the researchers said.
"We know that immune modulators known as cytokines are responsible for the
inflammation that is the hallmark of the disease, so research has focused on
discovering a viral or bacterial trigger," said Christopher Mantyh, M.D., colorectal
surgeon and senior member of the Duke team.
"However, our studies have shown that by blocking the VR-1 receptor, we can halt the
development of IBD in an animal model," he continued. "So it would
appear that the activation of the VR-1 receptor is the signal, or trigger, that 'revs up'
the release of cytokines."
It has long been appreciated that sensory neurons within the intestinal system can play a
role in the development of inflammation. Key to this
process is Substance P, a neurotransmitter found in minute quantities in the human nervous
system and intestines. It is primarily involved in the
transmission of pain impulses and is also a potent pro-inflammatory mediator in the
intestines.
"Studies have shown that using Substance P antagonists as well as denervation --
either surgical or chemically -- can block some forms of
intestinal inflammation," Mantyh said. "However, what is missing is that
trigger. What was not known was how the nerve cells in the intestine were
stimulated to begin the inflammatory process."
In their experiments, the Duke team focused on the newly cloned VR-1 receptor, which can
be activated by heat, acid and capsaicin, the ingredient
that gives chili peppers their "heat."
Capsaicin stimulates the pain and heat response by binding, like a lock-and-key, to the
VR-1 receptors on neurons. Just as long-time chili
eaters find that prolonged consumption renders them immune to the peppers' effects,
over-stimulation of VR-1 receptors can cause them to become
desensitized.
The researchers used three groups of rats. The first group was administered capsaicin at
birth, which chemically denervated them by "overstimulating'
the VR-1 receptors to the point of inactivating them permanently. They were allowed to
reach adulthood. The second group, which were adults, were given
the agent capsazepine (CPZ), a VR-1 antagonists which blocks the receptor. The third
group, the control, received no additional treatments.
The team then induced colitis, or intestinal inflammation, in all three groups of rats by
giving them dextran sulphate sodium (DSS) in their water
for a week. The animals' reactions to the treatment were carefully monitored and after one
week, detailed studies were made of their intestinal tracts.
"In the control rats, DSS caused active colitis with its trademark ulceration of the
intestinal lining," Mantyh said. "However, the two other
groups showed significantly lower levels of disease. The treated rats were protected from
the damaging effects of DSS administration. This data
provides strong evidence that an animal model of colitis requires neurons containing VR-1.
"Inhibition of the VR-1 receptor in humans -- either by small doses of CPZ or other
antagonists -- may represent a novel therapeutic pathway to prevent
IBD," Mantyh continued.
The research was supported by grants from the National Institutes of Health, the American
Surgical Association and the Department of Veterans Affairs.
Other members of the Duke team were Naoki Kihara, M.D., Sebastion de la Fiente, M.D.,
Kazunori Fujino, M.D., Toku Takahashi, D.M.D., and Theodore
Pappas, M.D.
Return To Index
Increased
prevalence of irritable bowel syndrome in patients with bronchial asthma.
Roussos A, Koursarakos P, Patsopoulos D, Gerogianni I, Philippou N.
9th Department of Pulmonary Medicine, SOTIRIA Chest Diseases Hospital, Athens, Greece.
roumar26@yahoo.com
Irritable bowel syndrome (IBS) is one of the most common diseases of the gastrointestinal
tract. IBS may represent a primary disorder of gastrointestinal motility accompanied with
motor dysfunction in various extraintestinal sites. Recent studies suggest that IBS is
associated with bronchial hyper-responsiveness and bronchial asthma might be more
prevalent in IBS patients than in control subjects. The aim of our study was to assess the
prevalence of IBS in a cohort of asthmatic patients. We evaluated 150 patients with
bronchial asthma (71 males and 79 females, aged 45.1+/-14.9 years) and two control groups
including 130 patients with other pulmonary disorder and 120 healthy subjects. All
subjects enrolled (asthmatic and controls) completed the Greek version of the Bowel
Disease Questionnaire (BDQ). BDQ is a, previously validated, self-report instrument to
measure gastrointestinal symptoms. Diagnosis of IBS was based on Rome II criteria. The IBS
prevalence was significantly higher in asthmatics (62/150, 41.3%) than in subjects with
other pulmonary disorders (29/130, 22.3%, P<0.001) and healthy ones (25/120, 20.8%,
P<0.001). For all subjects studied, the prevalence of IBS was significantly higher in
females (78/214, 36.4%) than in males (38/186, 20.4%, P<0.001). The IBS prevalence in
asthmatic males was 29.5% vs. 15.2% in male patients with other pulmonary disorders
(P=0.002) and 14.2% in male healthy subjects (P=0.002). The IBS prevalence in asthmatic
females was 51.8% vs. 28.1% in females patients with other pulmonary disorders
(P<0.001) and 26.5% in females healthy subjects (P<0.001). None of the asthma
medications were associated with increased or decreased likelihood of IBS. We conclude
that patients with bronchial asthma have an increased prevalence of IBS. Further studies
are needed to clarify the potential pathogenetic mechanisms underlying the association
between IBS and asthma.
Publication Types:
Clinical Trial
Controlled Clinical Trial
PMID: 12556015
100 Trillion
Bacteria in Your Gut: Learn How to Keep the Good Kind There.
By Dr. Joseph Mercola with Rachael Droege
You probably don't think about your gut very often but this may make you start--the bacteria in your bowels outnuber the cells in your body by a factor of 10 to one. This gut flora has incredible power over your immune system, which, of course, is your body's natural defense system that keeps you healthy. In other words, the health of your body is largely tied into the health of your gut, and it's hard to have one be healthy if the other is not.
One of the reasons why your gut has so much power has to do with the 100 trillion bacteria--about three pounds worth--that line your intestinal tract. This is an extremely complex living system that aggressively protects your body from outside offenders.
However, if you are eating as many sugars as the typical American (about 175 pounds per year) then you are feeding the "bad" bacteria, which are more likely to cause disease than promote health, rather than promoting the "good" bacteria that help protect you from disease. Exposure to chemicals will also contribute to this disruption in your gut microflora, and over time the imbalance will lead to illness.
A large part of the influence of the "bad" bacteria is on the intestinal lining (mucousal barrier) that is over 300 square meters, or about the size of a tennis court.
Beneficial bacteria in your gut can help to boost the immune system, prevent allergic inflammation and food allergy, clear up eczema in children and heal the intestines from a variety of ailments.
Fortunately, you can influence the composition of the good and bad bacteria in your gut by optimizing your diet and supplementing it with a high-quality probiotic, or good bacteria. As written in a report in the October 2003 American Journal of Clinical Nutrition, “probiotics can act as partners of the defense system of the intestine.”
The typical American diet is so full of sugar and grains that--although I don’t often recommend supplements--nearly everyone can benefit from probiotics. You should look for a high potency, multi-strain variety, which can be found in most health food stores. Since the best type of probiotic to use can become highly specific, you may want to discuss the varieties with an experienced health food store employee.
I recommend probiotics to nearly all of our new patients, as it is a helpful start for their health recovery. This is not a lifetime recommendation, however. Once you are eating the right foods it is generally possible to maintain a healthy bacterial balance in your gut without the use of probiotics.
On a side note, probiotics are especially helpful when you are traveling in the event you get an infectious diarrhea. Typically, large doses of a high-quality probiotic--about one-half to one full bottle in one day--are quite useful for a rapid resolution of the diarrhea.
Management of
Irritable Bowel Syndrome American Family Physician 12/04/2002 By Elda Hauschildt
Irritable bowel syndrome (IBS) is a benign condition, despite the concerns patients
present about their symptoms, researchers in the United States point out.
Investigators from the US Naval Hospital in Jacksonville, Florida, say IBS is the most
common functional disorder reported of the gastrointestinal tract. It is also the most
common diagnosis made in gastroenterological practices.
Family doctors frequently treat patients with IBS, which accounts for up to 3.5 million
doctor visits each year in the US. At the same time, only 10 to 30 percent of patients
with IBS seek medical care, the researchers note.
They say at five-year follow-up 5 percent of IBS patients report complete recovery and up
to 30 percent report partial recovery.
"Diagnosis should be made using standard criteria after red flags that may signify
organic disease have been ruled out," the researchers suggest.
They also say an effective doctor-patient relationship is vital to successful management
of the condition. "A good doctor-patient relationship has also been shown to reduce
repetitive office visits. The patient may need to be reassured repeatedly of the positive
diagnosis, and specific patient concerns and fears will need to be addressed."
The investigators point out that while no specific dietary advice has been shown to be
efficacious in research, it has been suggested that patients limit alcohol, caffeine,
sorbitol and fat intake.
Lactose elimination is only recommended when patients prove to have lactase deficiency.
They add that if a patient believes a particular dietary substance exacerbates symptoms,
an elimination trial is warranted. But, "In general, there is no association between
IBS and food intolerance."
American Family Physician, 2002; 66: 1867-1874. "Management
of Irritable Bowel Syndrome"
Transcript of a WebMD Live Chat on "What Can I eat when I have IBS?". The speaker was Elaine Magee, MPH, RD. Elaine has a degree in nutrition and a master's from the University of California at Berkeley in public health nutrition, she is a registered dietician and her job, so to speak, is helping people make better food choices. She has written 18 books so far, and has a national column called the Recipe Doctor. (You will have to register at this website to be able to access the articles. Registry is free and only take a minute) Once you register, just do a search for the article by typing in "Tell Me What to Eat if I Have Irritable Bowel Syndrome: Nutrition You Can Live With"
Fibromyalgia in
patients with irritable bowel syndrome An association with the severity of the intestinal
disorder
International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and
Surgery
ISSN: 0179-1958 (printed version) ISSN: 1432-1262 (electronic version) Abstract Volume 16
Issue 4 (2001) pp 211-215 DOI 10.1007/s003840100299 Ennio Lubrano (1), Paola Iovino
(2)(3), Fabrizio Tremolaterra (4), Wendy J. Parsons (5), Carolina Ciacci (4), Gabriele
Mazzacca (4) (1) Physical Medicine and Rehabilitation Department, University Federico II,
Naples, Italy (2) Endoscopic Unit, University Federico II, Naples, Italy E-mail: piovino@unina.it Phone: +39-81-7462759 Fax:
+39-81-7462759
(3) Via del Rione Sirignano 10, 80121 Naples, Italy (4) Gastroenterology Unit, University
Federico II, Naples, Italy (5) Research and Development Department, Leeds General
Infirmary, Leeds, UK
Accepted: 14 February 2001 / Published online: 27 April 2001
Abstract. Fibromyalgia (FM) syndrome and irritable bowel syndrome (IBS)
are functional disorders in which altered somatic and or visceral perception thresholds
have been found. The aim of this study was to evaluate the prevalence of FM in a group of
patients with IBS and the possible association of FM with patterns and severity of the
intestinal
disorder. One hundred thirty consecutive IBS patients were studied. The
IBS was divided into four different patterns according to the predominant
bowel symptom and into three levels of severity using a functional severity index. All
patients underwent rheumatological evaluation for number of positive tender points, number
of tender and swollen joints, markers of inflammation, and presence of headache and
weakness. Moreover,
patients' assessments of diffuse pain, mood and sleep disturbance, anxiety, and fatigue
were also measured on a visual analogue scale. The diagnosis of FM was made based on
American College of Rheumatology classification criteria. Nonparametric tests were used
for statistical
analysis. Fibromyalgia was found in 20% of IBS patients. No statistical association was
found between the presence of FM and the type of IBS but a significant association was
found between the presence of FM and severity of the intestinal disorder. The presence of
FM in IBS patients
seems to be associated only with the severity of IBS. This result confirms previous
studies on the association between the two syndromes
Link Between Poor
Sleep and Irritable Bowel Syndrome Studied by ImmuneSupport Staff
Researchers have documented a link between poor sleep and subsequent gastrointestinal
disturbances, both common problems for people with chronic fatigue syndrome (CFS) and
fibromyalgia (FM). The University of Washington study followed women with IBS and found
that more gastrointestinal disturbances occurred after a night of poor sleep. This news is
the most recent supporting the possibility of a casual relationship between the two.
Over the course of the 2-month analysis, 82 women with IBS and 35 women without used a combination of 7-day recall and a daily diary to test the relationship between the two ailments. Approximately 25% of the IBS women suffered from sleep disturbances. The severity of the disturbance correlated strongly with the severity of gastrointestinal symptoms.
Although the relationship between IBS and gastrointestinal symptoms remained significant even after researchers adjusted for psychological stress, they noted that this adjustment weakened the possibility of a definitive relationship.
A brief analysis of the data showed that poor sleep on a single night leads to significantly increased symptoms on the following day, while increased symptoms on a particular day do not appear to cause sleep disturbances that night. Original report published in Digestive Diseases and Sciences.
Menses Heighten
Symptoms Among Women With Irritable Bowel Syndrome GUT 2002; 50: 471-4. By Harvey
McConnell
Women with irritable bowel syndrome (IBS) have significantly worse symptoms during their
menses and this is allied with a lower rectal pain threshold.
This has been found among 29 women with IBS whose rectal responses were
measured during four phases of their menstrual cycle in a study by Dr Lesley Houghton and
colleagues at the Department of Medicine, University Hospital of South Manchester,
Manchester, England.
The clinicians postulate that the guts of women with IBS, which are already acutely
sensitive, may be further sensitised by other triggers such as fluctuating hormone levels.
Clinicians note that healthy women have looser, and more frequent, stools during menses,
but firmer during the luteal phase. This may be related to cycling female sex hormones. At
the same time, they found in an earlier study that the menstrual cycle does not appear to
alter their rectal
motility or sensitivity.
Sex hormones also may be implicated in the pathogenesis IBS: more women than men suffer
from the condition and patients often report exacerbation of symptoms at the time of
menses.
All of the women's symptoms met the Rome criteria I for the diagnosis of IBS: normal
hematology, biochemistry, and sigmoidoscopy, together with a normal colonoscopy or barium
enema if they were aged over 40. Their menstrual cycles were a mean normal of 27 days, and
none resorted any .
gynecological symptoms, taking the oral contraceptive or a drug known to effect
gastrointestinal motility.
Clinicians measured their responses to serial inflation of a balloon catheter inserted
into the unprepared rectums during days one to four (menses), eight to 10 (follicular
phase), 18 - 20 (luteal phase), and 24 - 28 (premenstrual phase) of the menstrual cycle.
Insertions were done
during the same time of day. In addition, the women kept a diary of symptoms to assess
abdominal pain and bloating and bowel habits. Any anxiety or depression were assessed by a
hospital questionnaire.
Dr Houghton found the women reported that abdominal pain and bloating were significantly
worse during menses. Bowel habits became more frequent and, while the women said they felt
less well, clinicians found no allied evidence that they were more depressed or anxious.
The clinicians found that rectal sensitivity among the women increased at menses compared
with all other phases of the cycle. Balloon distension needed to induce urge and
discomfort were all lower. However, there were no differences in motility or rectal
tension and pressure, suggesting
that the increased sensitivity was independent of any other bowel changes.
Dr Houghton and colleagues conclude: "Women with IBS appear to be predisposed to
fluctuations in visceral sensitivity associated with the menstrual cycle. Understanding
the pathogenesis behind these changes should help to unravel some of the mechanisms of
visceral sensitization."
Return To Index
~NuLev relaxes the muscles of the intestine and slows down their movement. NuLev helps ease the pain of intestinal cramps and spasms associated with IBS and helps bowel habits return to normal.
~Hyoscyamine. Brand Names-: Anaspaz®,
Cystospaz®, Cystospaz-M®, Levbid®, Levsin®, Levsinex® Timecaps, Levsin S/L®
Why Is Hyoscyamine (Levsin) Prescribed?
Hyoscyamine is used to treat bladder
spasms, colic, peptic ulcers, IBS (Irritable Bowel Syndrome), pancreatitis, cystitis,
diverticulitis. Hyoscyamine works by decreasing the secretion of stomach fluids including
acid.
How Is Hyoscyamine (Levsin) Supplied?
Hyoscyamine comes in tablet, capsule, or liquid form and is taken by mouth. It is usually taken 2-4 times daily. Follow the directions carefully, and ask your doctor or pharmacist if you have any questions.
Precautions of Hyoscyamine (Levsin)
Always consult your doctor if you experience any allergic reactions to Hyoscyamine or other drugs.
Side Effects of Hyoscyamine (Levsin)
The following side effects are common symptoms that you may experience with this drug. Tell your doctor if they are severe or do not go away: dry mouth, constipation, drowsiness, headache, difficult urination, blurred vision, flushing, increased sensitivity to light.
Warnings of Hyoscyamine (Levsin)
Call your doctor immediately if you experience any of the following: diarrhea, eye pain, skin rash, rapid or irregular heart rate.
For more information on Hyoscyamine, please visit MEDLINEplus.
~Levsin Pronounced: LEV-sin
Generic name: Hyoscyamine sulfate
Other brand names: Anaspaz Levbid Levsinex NuLev. Levsin is an antispasmodic medication
given to help treat various stomach, intestinal, and urinary tract disorders that involve
cramps, colic, or other painful muscle contractions.
~Hyoscyamine
Generic Name: Hyoscyamine (HYE-oh-SYE-a-meem)
Drug Class: Anticholinergic
~Levsin.
Warnings, interactions, precautions.
Zelnorm (tegaserod maleate) was approved for the short-term treatment of women with IBS marked primarily by constipation.
2002-07-25 11:00:40 -0400 (Reuters Health)
WASHINGTON (Reuters Health) - The US Food and Drug Administration (FDA) said on Wednesday it has approved the first drug for women with one form of irritable bowel syndrome (IBS).
Novartis Pharmaceuticals' Zelnorm (tegaserod maleate) was approved for the short-term treatment of women with IBS marked primarily by constipation. Novartis said it plans an early fall launch for the drug.
The FDA stressed that Zelnorm doesn't cure IBS or treat diarrhea-prominent IBS. But it has been shown to reduce constipation, bloating and abdominal discomfort, the agency said.
GlaxoSmithKline recently won US approval for a limited re-introduction of Lotronex (alosetron) for the treatment of women with severe IBS characterized by diarrhea. That drug was pulled off the market in late 2000 due to safety concerns.
Novartis originally expected FDA approval of Zelnorm in 2001, but the FDA requested additional information to resolve safety concerns and conflicting efficacy data. A Novartis spokesperson noted on Wednesday that Zelnorm will not have to be sold under the marketing restrictions that are in place for Lotronex.
The FDA said its decision to approve Zelnorm was based on results from three studies in which more patients on the drug than on placebo reported alleviation of symptoms during a 3-month period. The agency noted that effects appeared greater after one month than after 3 months, which it said suggests the benefits may decrease over time. The effects of Zelnorm beyond 3 months were not studied.
Zelnorm is the first in a new class of drugs called serotonin-4 receptor agonists, Novartis said. The drug activates these receptors to stimulate the peristaltic reflex, which helps normalize the gastrointestinal tract's motility.
The most common side effects in clinical studies were headaches and diarrhea, according to the firm. The company noted that the majority of patients who reported diarrhea had only one episode and that the side effect generally resolved itself without discontinuation of Zelnorm therapy.
More patients in the treatment group than in the placebo group had abdominal surgeries, but there is no proof of a causal relationship, according to the FDA.
The Novartis spokesperson estimated the potential US patient population for Zelnorm at about 10 million women and said the drug will be priced comparably to other gastrointestinal therapies.
Zelnorm's effect on men has not been established.
The drug is already approved in about 30 other countries, including Australia, Switzerland, Canada and Brazil. Novartis is investigating its use in other gastrointestinal disorders, such as chronic constipation and indigestion.
Otilonium Bromide Confirmed As More
Effective Than Placebo For Irritable Bowel Pain
European Journal of Gastroenterology and Hepatology, 2002;14: 1331-1338.
"Extended analysis of a double-blind, placebo-controlled, 15-week study with
otilonium bromide in irritable bowel syndrome." 12/23/2002 10:15:32 AM By Elda
Hauschildt
Otilonium bromide is more effective than placebo in relieving pain and discomfort in
patients with irritable bowel syndrome (IBS), Italian research confirms. Investigators
from the University of Bologna, SS Giovanni e Paolo Hospital in Venezia and Menarini
Ricerche spa in Firenze did an efficacy
assessment of a large clinical trial of otilonium bromide therapy in 378 patients. Trial
participants were treated with either 40 milligrams of otilonium bromide or placebo three
times a day for 15 weeks. Data on 12 single efficacy endpoints were assessed. The new
efficacy evaluation of the
double-blind, parallel-group study was based on information reported by
patients. Investigators used an assessment that integrated key IBS symptoms.
These included pain frequency and intensity as well as the presence of
meteorism and distension. The primary efficacy outcome measure was the rate
of response within two to four months of therapy. Results indicate response
within two to four months was significantly higher in patients in the
otilonium bromide group (36.9 percent) than in the placebo group (22.5percent). "In
each month of treatment, the rate of monthly response was
higher in the otilonium bromide group as compared with the placebo group,"
the researchers report. Differences in total monthly and weekly responses to
individual endpoints were also significantly more frequent in the otilonium
bromide group. These endpoints were: intensity/frequency of pain/discomfort,
meteorism/abdominal distension, diarrhoea/constipation severity and mucus in
the stool. Patients with diarrhoea had an additional benefit, the investigators add
Irritable Bowel Tied to Fat and Fructose Steven Reinberg HealthDay Reporter
MONDAY, Oct. 13 (HealthDayNews) -- Two new studies suggest fat and fructose, a sugar found in many fruits and honey, play key roles in causing gastrointestinal disorders.
Both studies were presented Oct. 13 at the American College of Gastroenterology annual meeting in Baltimore.
In the first report, Nancy Kraft, a clinical dietitian from the University of Iowa, and her colleagues say patients with irritable bowel syndrome (IBS) who are fructose-intolerant can achieve a significant improvement in symptoms by following a diet that restricts fructose intake.
Kraft says fructose intolerance is an often overlooked component of IBS.
Her colleague, Dr. Young Choi, adds in a statement that "a fructose-restricted diet significantly improved symptoms in patients with IBS and fructose intolerance. Fructose intolerance is yet another piece of the IBS puzzle, whose treatment when adhered to confers significant benefit."
In the study, the researchers looked at 80 patients with suspected IBS. Of these they found 30 were fructose-intolerant. Kraft's team taught these patients how to eliminate fructose from their diet. After one year, 26 patients were interviewed to assess their symptoms.
Among the 14 patients who stuck to the diet, there was a significant reduction in symptoms such as abdominal pain, bloating and diarrhea. In addition, there was a decline in IBS in this group.
However, bowel symptoms remained the same for the 12 patients who did not stick with the diet, the researchers report.
Kraft believes these results are encouraging, since "people who limit their intake of fructose see their symptoms improve or disappear," but that further study is needed.
In the second study, researchers from the Mayo Clinic in Rochester, Minn., led by Dr. Yuri Saito, collected data on the diets of 221 adults, aged 20 to 50. Of these patients, 102 had gastrointestinal disorders and 119 were healthy.
The research team found patients with IBS or dyspepsia reported eating more monounsaturated fats compared to healthy patients. These patients also ate fewer carbohydrates than their healthy counterparts.
The Mayo investigators conclude that "future studies are needed to determine whether fat intake causes gastrointestinal symptoms."
Dr. Theodore M. Bayless, a professor of medicine at Johns Hopkins University, finds both reports of value. He is not surprised fat and fructose are linked with IBS and dyspepsia.
He notes that both fat and fructose are hard to digest and can aggravate both conditions. Bayless, however, does not believe that restricting fructose cures IBS; it only relieves the symptoms.
Bayless says "anyone who is gassy with or without IBS will benefit by decreasing the intake of fructose."
He advises his patients to avoid fatty foods and foods that contain high levels of fructose such as grapes, dates, nuts, honey and apple or pear juice.
He also advises patients to increase fiber intake to make their bowels perform regularly.
IBS Patients May Benefit From Leaving Certain Foods Out of Their
Diet
Fat, Fructose May Worsen Gastric Upset By
Charlene Laino
Oct. 13, 2003 (Baltimore) -- Can avoiding certain foods help to relieve thebloating, tummy
aches and general misery associated with irritable bowel
syndrome?
That's the intriguing possibility raised by two new studies that show thatfat and
fructose, the simple sugar found in honey, fruits, and some soft
drinks, may contribute to symptoms of the misunderstood gastrointestinalsyndrome that
affects more than 1 in 10 Americans.
The research was presented here this week at the 68th Annual ScientificMeeting of the
American College of Gastroenterology. Young K. Choi, MD, of
the University of Iowa in Iowa City, studied people with irritable bowelsyndrome, or IBS,
whose bodies cannot absorb fructose properly.
Irritable bowel syndrome is one of the most common gastrointestinaldisorders, affecting
almost 58 million Americans. People who suffer from it
have symptoms of abdominal discomfort or pain, and they can alternatebetween diarrhea and
constipation.
In this study, those who were able to eliminate fruit and otherfructose-rich foods from
their diet were rewarded with an improvement in
symptoms, Choi says.
While not as well known as lactose intolerance, fructose intolerance isquite common,
affecting one-third to one-half of patients with symptoms of
IBS, Choi says.
The researchers tested 80 patients with suspected IBS; 30 were found to be fructose
intolerant. The patients were taught what foods are high in
fructose and urged to avoid them.
After one year, interviews with 26 of the patients showed that only one-half stuck to the
fructose-restricted diet, Choi says. But those who did stick
with the program reported significantly less abdominal pain, bloating, and diarrhea than
before changing their diets, he says. Not surprisingly, those
who cheated on their diets showed no improvement in symptoms.
Avoiding fructose is no easy task, says Kevin W. Olden, MD, associate professor of
medicine in the division of gastroenterology at the Mayo Clinic
in Scottsdale, Ariz. High-fructose corn syrup is a hidden ingredient in everything from
cola to lemonade, he says.
Richard G. Locke III, also of the Mayo Clinic, says he wonders whether patients in the
study really had IBS. Fructose intolerance can cause pain,
bloating, and diarrhea -- the same symptoms associated with irritable bowel syndrome.
"We used to think people who were intolerant to milk had IBS, but now we know they
have lactose intolerance," Locke says. "The same thing could be
happening here. It's a matter of labeling."
The important thing is to know that fructose can cause these symptoms, says Yuri A. Saito,
MD, MPH, also of the Mayo Clinic. "Most people are not even
aware of this."
In the second study, Saito and colleagues in the division of gastroenterology and
hepatology found that people with IBS tend to reach for
high-fat, low-carb foods. These dietary factors may contribute to some of the symptoms
suffered by gastrointestinal disorders such as IBS.
They are also significantly more likely to suffer from food allergies than people who
don't have gastric woes, the study suggests.
The researchers studied 221 Minnesotans, about half of whom suffered from IBS or other
gastrointestinal problems. All the participants filled out
detailed questionnaires that asked about their diet, and about half of those in each group
also kept a diet diary for one week itemizing exactly what
they ate and when.
The study showed that fat comprised a greater proportion of the total calories taken in by
people with IBS each day for healthy people.
Carbohydrates, on the other hand, accounted for a lower proportion of their total caloric
intake.
No significant differences were found for protein, fiber, iron, calcium, niacin, or
vitamins B, C, D, or E.
Saito says further studies are needed to look at whether fat causes gastrointestinal
symptoms in people with IBS.
In the meantime, she does not recommend any blanket change in diet recommendations.
Instead, people who suffer from IBS should work with a
doctor, nurse, or nutritionist to uncover any foods that make them feel worse.
Olden, who was not involved with the study, agrees. "I advise my patients to eat what
they enjoy. If they identify a food that makes them feel sicker,
they should not eat that food. "But you can't tell everyone not to eat
cornflakes."
SOURCES: The 68th Annual Scientific Meeting of the American College of Gastroenterology,
Baltimore, Oct. 12-15, 2003. Young K. Choi, MD, University
of Iowa, Iowa City. Richard G. Locke III, associate professor of medicine, Mayo Clinic,
Rochester, Minn. Kevin W. Olden, MD, associate professor of
medicine, Mayo Clinic, Scottsdale, Ariz. Yuri A. Saito, MD, MPH, Mayo Clinic, Rochester,
Minn.
Return To Index
Irritable Bowel Syndrome's Possible Genetic Link Studied by Mayo
Clinic Researchers
ROCHESTER, Minn., Dec. 10 (AScribe Newswire) -- Researchers at Mayo Clinic studying
irritable bowel syndrome say their study of people with this disorder suggests genetic
factors may play a role.
Irritable bowel syndrome is a common problem affecting about one in 10 adults. However,
many people don't talk about irritable bowel syndrome, which causes abdominal cramping,
constipation and diarrhea. The study, which is published in the December issue of Gut, an
international journal in gastroenterology, shows that the risk of having irritable bowel
syndrome is nearly double in the families of people with the disorder.
"The next challenge is determining nature versus nurture," said G. Richard
Locke, M.D., a Mayo Clinic gastroenterologist and one of the authors of the study.
"Is this due to a gene or genes or is it due to a shared environmental factor? Our
group is active in investigating these issues."
In developing the study, researchers noted that people with irritable bowel syndrome often
report family members with similar symptoms. The researchers hypothesized that if there is
a familial connection, there would be an increased frequency of irritable bowel syndrome
in direct relatives of irritable bowel syndrome patients compared to relatives of people
without irritable bowel syndrome.
Others who conducted the study include Jamshid Kalantar, M.D., Alan Zinsmeister, Ph.D.,
Christopher Beighley, and Nicholas Talley, M.D., Ph.D. Dr. Kalantar was a research fellow
at Mayo Clinic during the study, but is now with the Department of Medicine, University of
Sydney, Australia. Mr. Beighley now works in West Virginia. The others are with Mayo
Clinic in Rochester.
In the study, patients with irritable bowel syndrome seen at Mayo Clinic and their spouses
filled out a bowel disease questionnaire and provided the names and addresses of their
direct relatives. Researchers then sent a bowel disease questionnaire to 355 relatives of
the patients and their spouses, and 71 percent responded. Irritable bowel syndrome
occurred in 17 percent of the patients' relatives compared with 7 percent in spouses'
relatives.
Diet may play role in IBS and dyspepsia
Studies link fructose and fat to IBS symptoms
Contact: Malaika Hilliard
mhilliard@porternovelli.com
202-973-5896
American College of Gastroenterology
BALTIMORE (October 13, 2003)-- Two recent studies released today attempt to unravel the
role that diet plays in gastrointestinal disorders such as irritable bowel syndrome (IBS)
and dyspepsia. The preliminary findings suggest that both fructose and fat contribute to
symptoms of IBS, a disorder affecting about 10 to 15 percent of the American population.
The findings will be presented at the 68th Annual Scientific Meeting of the American
College of Gastroenterology.
For several years, University of Iowa researchers have been investigating how fructose,
the simple sugar found in honey and many fruits, may play an important role in some of the
symptoms of IBS, a leading cause of referral to a gastroenterologist. IBS is characterized
by abdominal discomfort, bloating, and change in bowel habits (constipation and/or
diarrhea).
Although lactose intolerance is well-known, fructose intolerance is just beginning to be
recognized. Young K. Choi, M.D., and colleagues from the University of Iowa Hospitals and
Clinics (Iowa City, IA) found previously that one-third to one-half of patients with IBS
symptoms are fructose intolerant.
"A fructose-restricted diet significantly improved symptoms in patients with IBS and
fructose intolerance," said Dr. Choi. "Fructose intolerance is yet another piece
of the IBS puzzle, whose treatment -- when adhered to -- confers significant
benefits."
For this study, the University of Iowa researchers tested 80 patients with suspected IBS
and found that 30 were fructose intolerant. Patients were taught about eliminating
fructose from their diet, and after one year, 26 were interviewed to assess their
symptoms. Only one-half of the patients complied with the fructose-restricted diet.
For those who were compliant, symptoms (such as abdominal pain, bloating, and diarrhea)
declined significantly (P .LT. 0.05) from their reported symptoms before the diet
modification. Also, the prevalence of IBS in this group declined. For the group that did
not comply with the diet modification, bowel symptoms stayed the same over the study
period. Given the modest number of patients, additional confirming studies would be an
important prerequisite to consideration of a modification in general disease management
strategies in IBS.
In the second study, Yuri A. Saito, M.D., M.P.H., and colleagues of the Division of
Gastroenterology and Hepatology at Mayo Clinic and Foundation (Rochester, MN) attempted to
tease out the dietary factors that may explain some of the symptoms of functional
gastrointestinal disorders, such as IBS and dyspepsia. Their population-based study
provides the framework for establishing whether dietary components are the causative
factors in the development of symptoms.
The investigators mailed a questionnaire to an age- and gender-stratified random sample of
Minnesotans aged 20 to 50 years old. Those who reported IBS or dyspepsia or who claimed no
GI symptoms had a physical exam and completed a survey on diet. Of the 221 participants
who completed the diet survey, 53 cases and 58 controls were asked to record their diet
for one week.
Dr. Saito and colleagues found that those with IBS or dyspepsia reported consuming a
significantly higher proportion of fat in their diet (33.0 percent for those with GI
disorders, 30.7 percent for controls, P .LT. 0.05). No significant differences were found
for protein, fiber, iron, calcium, niacin, or vitamins B1, B2, B6, B12, C, D, or E.
"Future studies are needed to determine whether fat intake causes gastrointestinal
symptoms," said Dr. Saito.
Return To Index
Inflammatory Bowel
Disease and Irritable Bowel Syndrome: Separate or Unified?
Posted 07/15/2003
Sylvie Bradesi, PhD, James A. McRoberts, Ph.D, Peter A. Anton, MD, Emeran A. Mayer, MD
Abstract and Introduction
Abstract
Both irritable bowel syndrome and inflammatory bowel diseases share symptoms of altered
bowel habits associated with abdominal pain or discomfort. Irritable bowel syndrome has
been referred to as a functional bowel disorder, which is diagnosed by a characteristic
cluster of symptoms in the absence of detectable structural abnormalities. Inflammatory
bowel disease is a heterogeneous group of disorders characterized by various forms of
chronic mucosal and/or transmural inflammation of the intestine. In this review, the
authors discuss recent evidence suggesting several potential mechanisms that might play a
pathophysiologic role in both syndromes. Possible shared pathophysiologic mechanisms
include altered mucosal permeability, an altered interaction of luminal flora with the
mucosal immune system, persistent mucosal immune activation, alterations in gut motility,
and a role of severe, sustained life stressors in symptom modulation. It is proposed that
similarities and differences between the two syndromes can best be addressed within the
framework of interactions between the central nervous system and the gut immune system.
Based on recent reports of low-grade mucosal inflammation in subpopulations of patients
meeting current diagnostic criteria for irritable bowel syndrome, therapeutic approaches
shown to be effective in inflammatory bowel disease, such as probiotics, antibiotics, and
antiinflammatory agents, have been suggested as possible therapies for certain patients
with irritable bowel syndrome.
Complete article here: http://www.medscape.com/viewarticle/457728_1
Curr Opin Gastroenterol 9(4):336-342, 2003. © 2003 Lippincott Williams & Wilkins
